中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2015年
4期
350-353
,共4页
结核,中枢神经系统%肉芽肿%椎管
結覈,中樞神經繫統%肉芽腫%椎管
결핵,중추신경계통%육아종%추관
Tuberculosis,central nervous system%Granuloma%Spinal canal
目的 探讨以肉芽肿包裹性压迫为特征的椎管内结核性肉芽肿的临床表现、影像学特点及外科手术治疗的方法和效果.方法 回顾性纳入15例椎管内结核性肉芽肿患者,均行病变所在节段全椎板减压术加结核性肉芽肿部分切除术,开放硬脊膜沟通椎管内外血运.术后继续应用抗结核药物≥1年.结果 15例患者手术区域共涉及l～7个节段,最高为枕颈交接部位,最低为腰1节段;肉芽肿长度3～ 16 cm.病变组织主要位于髓外蛛网膜下腔,平卧位上胸段生理弯曲低点最常见.硬脊膜与肉芽肿能够完全分离.从出现神经功能损害到手术时间最短3d,最长1个月;最短者预后相对最好,最长者预后最差.术后2周,2例肌力由Ⅰ级升至Ⅳ级,Frankel分级由C级恢复为D～E级,13例肌力由Ⅱ级升至Ⅲ级,Frankel分级由C级恢复至D级.随访1个月至3年,所有患者均有不同程度的神经功能恢复;术后2个月,MRI示11例术区肉芽肿消失,与术区临近区域肉芽肿也基本消失;术后6个月,MRI示9例术区及毗邻区域肉芽肿均完全消失.结论 手术能改善椎管内结核性肉芽肿的临床预后,出现神经功能缺损后越早手术预后越好.手术减压可明显增强临近的非手术节段的药物抗结核效果.
目的 探討以肉芽腫包裹性壓迫為特徵的椎管內結覈性肉芽腫的臨床錶現、影像學特點及外科手術治療的方法和效果.方法 迴顧性納入15例椎管內結覈性肉芽腫患者,均行病變所在節段全椎闆減壓術加結覈性肉芽腫部分切除術,開放硬脊膜溝通椎管內外血運.術後繼續應用抗結覈藥物≥1年.結果 15例患者手術區域共涉及l～7箇節段,最高為枕頸交接部位,最低為腰1節段;肉芽腫長度3～ 16 cm.病變組織主要位于髓外蛛網膜下腔,平臥位上胸段生理彎麯低點最常見.硬脊膜與肉芽腫能夠完全分離.從齣現神經功能損害到手術時間最短3d,最長1箇月;最短者預後相對最好,最長者預後最差.術後2週,2例肌力由Ⅰ級升至Ⅳ級,Frankel分級由C級恢複為D～E級,13例肌力由Ⅱ級升至Ⅲ級,Frankel分級由C級恢複至D級.隨訪1箇月至3年,所有患者均有不同程度的神經功能恢複;術後2箇月,MRI示11例術區肉芽腫消失,與術區臨近區域肉芽腫也基本消失;術後6箇月,MRI示9例術區及毗鄰區域肉芽腫均完全消失.結論 手術能改善椎管內結覈性肉芽腫的臨床預後,齣現神經功能缺損後越早手術預後越好.手術減壓可明顯增彊臨近的非手術節段的藥物抗結覈效果.
목적 탐토이육아종포과성압박위특정적추관내결핵성육아종적림상표현、영상학특점급외과수술치료적방법화효과.방법 회고성납입15례추관내결핵성육아종환자,균행병변소재절단전추판감압술가결핵성육아종부분절제술,개방경척막구통추관내외혈운.술후계속응용항결핵약물≥1년.결과 15례환자수술구역공섭급l～7개절단,최고위침경교접부위,최저위요1절단;육아종장도3～ 16 cm.병변조직주요위우수외주망막하강,평와위상흉단생리만곡저점최상견.경척막여육아종능구완전분리.종출현신경공능손해도수술시간최단3d,최장1개월;최단자예후상대최호,최장자예후최차.술후2주,2례기력유Ⅰ급승지Ⅳ급,Frankel분급유C급회복위D～E급,13례기력유Ⅱ급승지Ⅲ급,Frankel분급유C급회복지D급.수방1개월지3년,소유환자균유불동정도적신경공능회복;술후2개월,MRI시11례술구육아종소실,여술구림근구역육아종야기본소실;술후6개월,MRI시9례술구급비린구역육아종균완전소실.결론 수술능개선추관내결핵성육아종적림상예후,출현신경공능결손후월조수술예후월호.수술감압가명현증강림근적비수술절단적약물항결핵효과.
Objective To study the clinical,imaging characteristics,surgical treatments and results of spinal tuberculous granuloma.Methods A total of 15 cases of spinal tuberculous granuloma were retrospectively studied.Laminectomy with partial excision of tuberculous granuloma,open spinal dura mater with communication inside and outside the blood supply,and postoperative continued application of anti-TB drugs ≥ 1 year were performed.Results The surgery area covered 1-7 segment,up to the neck pillow,and down to the lumbar segments.The granuloma length was 3-16 cm.The lesions located mainly in extramedullary of subarachnoid cavity,most commonly seen in the lower point of the physiological curvature of the thoracic subarachnoid cavity.The granuloma could be entirely separated from the dura.From the appearance of neurological damage to the surgery,the shortest time was 3 days,the longest time was 1 month.The prognosis of patients with short duration was better than that of those with a long time.Two weeks after surgery,the muscle strength of 2 cases was increased from grade Ⅰ to grade Ⅳ and the Frankel classification changed from C to D-E.The muscle strength of 13 cases was increased from grade Ⅱ to grade Ⅳ,and the Frankel classification changed from C to D.The follow-up duration was from 1 month to 3 years.Varying degrees of neurological recovery were observed in all the patients.After two months,the MRI of 11 cases showed disappearance of granulomas around the surgical area.After six months,the MRI of 9 cases showed that the granulomas of surgical and non-surgical areas were completely disappeared.Conclusion Surgical decompression could improve the prognosis of spinal tuberculous granuloma.After neurological damage occurred,the sooner the surgery performed,the better the prognosis.
