骶管蛛网膜囊肿不同治疗方法的疗效比较VIP专享VIP免费

ChineseJournalofReparativeandReconstructiveSurgery,February2010,Vol.24,No.2·206·骶管蛛网膜囊肿不同治疗方法的疗效比较王佰川邵增务吴宏斌杨述华吴永超马智林于鹏【摘要】目的比较采用两种手术方法治疗骶管蛛网膜囊肿的疗效。方法2004年1月－2009年3月，分别采用切除棘突、椎板开窗摘除囊肿术（A组25例）和CT引导经皮穿刺医用生物蛋白胶封闭囊肿术（B组30例）治疗55例有临床症状的骶管蛛网膜囊肿患者。其中男23例，女32例；年龄15～66岁，平均42.6岁。病程6个月～15年，平均3.5年。囊肿部位：L5、S122例，S1、225例，S2、312例，S28例，骶前2例。囊肿大小为1.5cm×1.0cm～6.0cm×2.8cm。均经MRI检查确诊为骶管蛛网膜囊肿。两组患者性别、年龄、病程、囊肿大小比较差异均无统计学意义（P>0.05），具有可比性。比较两组患者围手术期及术后腰骶区疼痛和功能改善情况。结果两组患者均顺利完成手术，B组手术时间、术中出血量、住院时间均明显少于A组（P<0.01）。55例均获随访，随访时间9～61个月，平均23个月。A组术后均发生脑脊液漏，发生颅内感染2例，神经损伤3例，出现神经根刺激症状8例；B组术后出现头痛、颈项僵硬等轻度脑膜炎征象3例，低热5例；均经对症治疗后治愈（神经损伤除外）。A组术后6、7个月，B组术后7个月复查各复发1例，其中A组1例及B组1例再次行CT引导经皮穿刺医用生物蛋白胶封闭囊肿术，囊肿缩小或消失；余患者随访时均未见复发。两组患者末次随访时Oswestry功能障碍指数和视觉疼痛模拟评分均较术前明显改善（P<0.01），两组间评分改善率比较差异均有统计学意义（P<0.01）。根据评分等级，A组疼痛改善优良率为64%，B组为100%；A组功能改善优良率为24%，B组为97%。结论CT引导经皮穿刺医用生物蛋白胶封闭治疗骶管蛛网膜囊肿具有创伤小、安全可靠、疗效确切、住院时间短、费用低廉等优点，是目前治疗骶管囊肿的一种较好选择。【关键词】骶管蛛网膜囊肿生物蛋白胶CT引导微创技术疗效比较中图分类号：R322.81R686.1文献标志码：AEFFECTCOMPARISONOFARACHNOIDCYSTSINSACRALCANAL/WANGBaichuan,SHAOZengwu,WUHongbin,YANGShuhua,WUYongchao,MAZhilin,YUPeng.DepartmentofOrthopedics,WuhanUnionHospital,TongjiMedicalCollege,HuazhongUniversityofScienceandTechnology,WuhanHubei,430022,P.R.China.Correspondingauthor:SHAOZengwu,E-mail:szwjj@medmail.com.cn【Abstract】ObjectiveToevalutetheclinicaloutcomesoftwodifferentsurgicaltreatmentsforarachnoidcystsinsacralcanal.MethodsFromJanuary2004toMarch2009,55casesofarachnoidcystsinthesacralcanalweretreatedbytraditonalsimplesacrallaminectomieswithresectionofthecysts(groupA,25cases)andnovelCT-guidedpercutaneousfibringluetherapyofarachnoidcysts(groupB,30cases).Ofthem,therewere23malesand32females,aging15-66yearswithanaverageof42.6years;thedurationofsymptomswas6monthsto15yearswithanaverageof3.5years.L5-S1wasinvolvedin22cases,S1,2in25cases,S2,3in12cases,S2in8cases,andpresacralin2cases.Thesizeofcystswas1.5cm×1.0cmto6.0cm×2.8cm.TheMRIexaminationshowedthatallpatientshadcystsinthesacralcanal.Therewerenosignificantdifference(P>0.05)insex,ages,diseasedurationandcystssizebetweentwogroups.Preoperativedataandpostoperativelumbosacralpainandfunctionimprovementwereanalyzedandcomparedbetweentwogroups.ResultsAlloperationswereperformedsuccessfully.Theoperativetime,bloodlossandhospitalizationdaysofgroupBweresignificantlylessthanthoseofgroupA(P<0.01).All55caseswerefollowedupfrom9to61months(mean23months).IngroupA,postoperativecerebrospinalfluidleakage(25cases),intracranialinfection(2cases),nerveinjury(3cases),andnerverootirritation(8cases)occurred;ingroupB,mildmeningitis(3cases)andlowgradefever(5cases)occurred.Exceptfornerveinjury,othercomplicationswerecuredaftersymptomaticmanagement.Duringthefollow-up,2rec...