Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, 50.009 Zaragoza, Spain
Jt Dis Relat Surg. 2023;34(1):58-62. doi: 10.52312/jdrs.2023.825. Epub 2023 Jan 14.
This study presents our experience in surgical treatment of extravertebral bone hydatidosis and aims to investigate the utility of specific immunoglobulin E (IgE) in diagnosis and prognosis of the disease.
Between January 1990 and December 2019, a total of 10 patients (6 males, 4 females; mean age: 47.2±14.7 years; range, 27 to 71 years) with non-vertebral bone hydatidosis surgically treated in our hospital were retrospectively included. Curettage or wide resection was performed in all cases, followed by medical antihelminthic therapy. Specific IgE p2 was studied in seven patients during and at final follow-up.
At the time of diagnosis, secondary infection of the cyst was observed as the initial symptom in two patients mimicking an abscess and, in both cases, more surgeries were required without final healing. In two cases, over five specific IgE presented a false negative at the time of diagnosis and it was not correlated with clinical evolution in three cases over seven. In six cases, diagnosis was obtained before surgery. In treatment, pelvic disease had the worst prognosis (none healed) and bacterial overinfection was a common complication after surgery. At the final follow-up, only two femoral cases (20%) were free of disease. Other four cases (three in iliac bone, one in proximal femur) needed several surgeries without healing. The other four patients showed no progression or refused a new surgical treatment.
Location, bone defect, when it is possible to perform a radical surgery, and associated bacterial overinfection after surgery make cystic hydatidosis in bone an infection very difficult to treat definitively in humans. Negative specific IgE does not exclude bone hydatidosis.
本研究介绍了我们在治疗骨包虫病方面的经验，并旨在探讨特异性免疫球蛋白 E（IgE）在疾病诊断和预后中的作用。
1990 年 1 月至 2019 年 12 月，我们医院共收治了 10 例非脊柱骨包虫病患者（6 例男性，4 例女性；平均年龄：47.2±14.7 岁；年龄范围 27 岁至 71 岁），这些患者均接受了手术治疗。所有病例均行刮除术或广泛切除术，术后给予抗寄生虫药物治疗。7 例患者在治疗期间和最终随访时检测了特异性 IgE p2。
在诊断时，2 例患者以脓肿为首发症状出现包虫囊肿的继发感染，这两例患者需要进行更多的手术，但最终未治愈。在 7 例患者中，有 2 例患者的初始诊断时的 IgE 值大于 5，但与临床病程无关。在 6 例患者中，在术前获得了明确诊断。在治疗方面，骨盆病变的预后最差（均未治愈），且术后细菌过度感染是常见的并发症。在最终随访时，仅有 2 例股骨病变（20%）无疾病进展，4 例（3 例髂骨，1 例股骨近端）需要多次手术但未治愈，其他 4 例患者疾病无进展或拒绝进一步手术。
病变位置、骨缺损、是否可以进行根治性手术以及术后细菌过度感染，使得骨包虫病成为人类难以根治的感染性疾病。阴性的特异性 IgE 并不能排除骨包虫病的存在。
