胸腰段硬膜外囊肿的诊断与治疗  

Diagnosis and treatment of thoracolumbar epidural cyst

作　　者：刘火文 吴昊[1] 谢远龙[1] 蔡林[1] 雷军[1] LIU Huo-wen;WU Min-hao;XIE Yuan-long;CAI Lin;LEI Jun(Department of Spine Surgery and Musculoskeletal Tumor,Zhongnan Hospital of Wuhan University,Wuhan,Hubei,430071,China)

机构地区：[1]武汉大学中南医院脊柱与骨肿瘤科,湖北430071

出　　处：《中国骨与关节杂志》2020年第5期369-374,共6页Chinese Journal of Bone and Joint

摘　　要：目的探讨胸腰段硬膜外囊肿的诊断和治疗体会。方法回顾性分析2012年6月至2018年6月,在我院经治的20例胸腰段硬膜外囊肿病例的临床资料。男9例,女11例,年龄20~63岁,平均43.3岁;胸段13例,腰段7例,合计胸腰段20例。手术治疗15例,保守治疗5例。比较手术患者的术前和术后疼痛视觉模拟评分(visual analogue scale,VAS)、关键肌肉力量0~5级评分、日本骨科协会(Japanese orthopaedic association,JOA)评分、脊髓功能状态。结果根据Nabors分型,Ia型13例,II型7例。15例行囊肿切除术,4例无明显手术适应证者行保守治疗,1例拒绝手术。13例腰背部疼痛者VAS评分,术前(5.60±2.05)分,术后(1.67±0.60)分,较术前明显降低(P<0.05);4例肢体放射性疼痛者VAS评分,术后VAS(2.00±0.70)分,较术前(6.75±0.82)分,显著降低(P<0.05)。2例肢体无力者,术后肌力提高1~2级。1例括约肌功能障碍者,术后JOA评分(3分)较术前(2分)提高。术后随访,脊髓功能状态据McCormick分级,都达到I级。随访MRI检查未见囊肿复发。X线未见脊柱畸形等情况。结论MRI是诊断硬膜外囊肿的首选,术前明确囊肿定位,术中尽量不影响脊柱稳定性,尽可能将囊肿完整切除,可取得确切的临床疗效。Objective To investigate the diagnosis and treatment of thoracolumbar epidural cyst.Methods Clinical data of 20 patients(9 males,11 females)with thoracolumbar epidural cyst were collected from June,2012 to June,2018.The average age was 43.3 years(range:20-63 years).Thirteen thoracic and 7 lumbar epidural cyst patients were included.Fifteen patients underwent surgical treatment,while 5 patients underwent conservative treatment.Preoperative and postoperative VAS scores,key muscle strength 0-5 scores,JOA scores,and spinal cord functions were compared and analyzed.Results Nabors classification:13Ιa patients;7 II patients.VAS scores of 13 patients with low back pain postoperatively(1.67±0.60)were significantly lower than that preoperatively(5.60±2.05)(P<0.05).VAS scores of 4 patients with limb radiation pain postoperatively(2.00±0.70)were significantly lower than that preoperatively(6.75±0.82)(P<0.05).Postoperative muscle strength increased by 1-2 in 2 patients with limb weakness.JOA score of 1 patient with sphincter dysfunction postoperatively(3)was higher than that preoperatively(2).Functions of the spinal cord was gradedΙduring the follow-up according to the McCormick classification.No cyst recurrence or spine deformity was observed in MRI,X-ray,respectively.Conclusions MRI is a good option in the diagnosis and treatment of thoracolumbar epidural cyst.Accurate preoperative cyst positioning,intraoperative preservation of the spine stability,and complete cyst removal are required for satisfactory effects.

关 键 词：囊肿 硬膜外肿瘤 磁共振成像 诊断 治疗 

分 类 号：R739[医药卫生—肿瘤]