[骶管内蛛网膜囊肿的疗效比较]

Wang Baichuan, Shao Zengwu, Wu Hongbin, Yang Shuhua, Wu Yongchao, Ma Zhilin, Yu Peng

Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, 430022, P.R. China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Feb;24(2):206-10.

OBJECTIVE

To evaluate the clinical outcomes of two different surgical treatments for arachnoid cysts in sacral canal.

METHODS

From January 2004 to March 2009, 55 cases of arachnoid cysts in the sacral canal were treated by traditional simple sacral laminectomies with resection of the cysts (group A, 25 cases) and novel CT-guided percutaneous fibrin glue therapy of arachnoid cysts (group B, 30 cases). Of them, there were 23 males and 32 females, aging 15-66 years with an average of 42.6 years; the duration of symptoms was 6 months to 15 years with an average of 3.5 years. L5-S1 was involved in 22 cases, S1,2 in 25 cases, S2,3 in 12 cases, S2 in 8 cases, and presacral in 2 cases. The size of cysts was 1.5 cm x 1.0 cm to 6.0 cm x 2.8 cm. The MRI examination showed that all patients had cysts in the sacral canal. There were no significant difference (P > 0.05) in sex, ages, disease duration and cysts size between two groups. Preoperative data and postoperative lumbosacral pain and function improvement were analyzed and compared between two groups.

RESULTS

All operations were performed successfully. The operative time, blood loss and hospitalization days of group B were significantly less than those of group A (P < 0.01). All 55 cases were followed up from 9 to 61 months (mean 23 months). In group A, postoperative cerebrospinal fluid leakage (25 cases), intracranial infection (2 cases), nerve injury (3 cases), and nerve root irritation (8 cases) occurred; in group B, mild meningitis (3 cases) and low grade fever (5 cases) occurred. Except for nerve injury, other complications were cured after symptomatic management. During the follow-up, 2 recurrent cases were found in group A and 1 case in group B. Of them, 2 recurrent cases were treated with CT-guided percutaneous fibrin glue therapy of arachnoid cysts, and cysts disappeared. For two groups, there were significant differences in Oswestry functional disability index and visual analogue scale score between preoperation and postoperation (P < 0.01), and in the rate of score improvement between two groups (P < 0.01). According to the rating scale, the excellent and good rates of pain improvement were 64% in group A and 100% in group B; the excellent and good rates of function improvement were 24% in group A and 97% in group B.

CONCLUSION

CT-guided percutaneous fibrin glue therapy for arachnoid cysts in the sacral canal is a mini-invasive, safe, effective, and economical method, it may be better choices for the treatment of arachnoid cysts in the sacral canal.

目的

评估两种不同手术治疗骶管蛛网膜囊肿的临床疗效。

方法

2004年1月至2009年3月，55例骶管蛛网膜囊肿患者，其中25例行传统单纯骶管椎板切除术加囊肿切除术（A组），30例行新型CT引导下经皮蛛网膜囊肿纤维蛋白胶治疗（B组）。患者中男性23例，女性32例，年龄15 - 66岁，平均42.6岁；症状持续时间6个月至15年，平均3.5年。L5 - S1节段受累22例，S1,2节段25例，S2,3节段12例，S2节段8例，骶前2例。囊肿大小为1.5 cm×1.0 cm至6.0 cm×2.8 cm。MRI检查显示所有患者骶管内均有囊肿。两组患者在性别、年龄、病程及囊肿大小方面差异无统计学意义（P > 0.05）。分析比较两组患者术前资料及术后腰骶部疼痛和功能改善情况。

结果

所有手术均成功完成。B组手术时间、出血量及住院天数均显著少于A组（P < 0.01）。55例患者均获随访，随访时间9至61个月（平均23个月）。A组术后发生脑脊液漏25例、颅内感染2例、神经损伤3例、神经根刺激8例；B组发生轻度脑膜炎3例、低热5例。除神经损伤外，其他并发症经对症处理后治愈。随访期间，A组发现复发2例，B组1例。其中A组2例复发病例再次行CT引导下经皮蛛网膜囊肿纤维蛋白胶治疗，囊肿消失。两组患者术前与术后Oswestry功能障碍指数及视觉模拟评分差异有统计学意义（P < 0.01），两组评分改善率差异有统计学意义（P < 0.01）。根据评定标准，A组疼痛改善优良率为64%，B组为100%；功能改善优良率A组为24%，B组为97%。