骨包虫病的诊断及治疗

目的 回顾性分析骨包虫病的临床表现和X线征象，探讨其诊断、鉴别诊断及治疗方法。方法 自1957年10月～2004年2月收治的骨包虫病患者37例，男16例，女21例。年龄14～58岁，平均29岁。病史0．5～12年，平均3．1年。发病部位：颈椎2例，肩胛骨1例，胸椎11例，肋骨2例，腰椎5例，髂骨1例，骶骨6例，耻骨1例，髋关节2例，股骨转子间1例，股骨上段2例，胫骨上段1例，肱骨头1例，桡骨上段1例。所有患者均采用手术治疗，以病灶清除为主，部分患者行自体骨、异体骨、人工骨或骨水泥填塞。术后口服阿苯达唑(片剂或原粉每日20mg／kg；阿苯达唑脂质体每日10mg／kg)3个月，预防复发。结果 25例行皮内Casoni试验，阳性2l例(84%）。4例行包虫病八项免疫试验，均为阳性。21例行MR检查，18例诊断为骨包虫病。24例获随访者，随访时间2～20年，平均3．6年。11例复发(45．83％)，其中胸椎4例，腰椎2例，骶骨4例，髋关节l例。6例四肢骨包虫病患者未见复发。24例脊柱骨包虫病患者中16例有神经系统损害，Frankel分级A级l例，B级3例，C级3例，D级9例，所有病例术后均有不同程度改善。结论 骨包虫病好发于躯干骨，尤其是脊柱。其影像学表现与结核、转移癌、骨巨细胞瘤、骨囊肿等相似，应注意鉴别。MRI有助于脊柱包虫病的诊断，血清学检查是诊断骨包虫病的主要方法；脊柱包虫病伴脊髓压迫采用手术治疗症状改善明显，但病灶不易清除彻底，容易复发。

Treatment and diagnosis of bone hydatid disease

Objective To analyze the diagnosis and treatment of bone hydatid disease retrospectively. Methods From October 1957 to February 2004, thirty-seven consecutive cases, which were 16 males and 21 females, underwent debridement operation. The average age was 29 years ranging from 14 to 58 years. The history of bone hydatid disease was 3.1 years ranging from 0.5 to 12 years. The lesion was located at cervical vetebrae in 2, scapula in 1, thoracic vetebrae in 11, rib in 2, lumbar vetebrae in 5, ilium in 1, sacrum in 1, pelvic pubis in 1, hip joint in 2, femoral intertrochanter in 1, proximal humerus in 2, proximal tibia in 1, humeral head in 1, and proximal rudius in 1. The lesions of all cases were performed curettage thoroughly accepted and some of them received autogenetic or allogenetic bone graft, and artificial bone or bone cement was used to fill the defect in a few cases. Albendazole was used to prevent relapse for 3 months after operation, the dose of Albendazole tablets or powder was 20 mg/kg per day, or liposomal Albendazole 10 mg/kg per day. Results 24 cases were followed up; the period was 2 to 20 years with an average of 3.6 years. Of 37 cases, 31 were hydatid disease of trunk bone (83.78%), 24 were spinal hydatid disease. 25 of 37 cases were performed Casoni test, 21 cases were positive(84%). Four cases accepted the 8-tests immunodiagnosis for human hydatidosis, all were positive. MRI examination was taken in 21 of 37 cases, 18 cases were diagnosed as bone hydatid disease. In 24 cases which were followed up, 11 cases relapsed(45.83%). Conclusion Bone hydatid disease often occurs in the bone of trunk, especially in spine; the X-ray or CT images of bone hydatid disease are similar to tuberculosis, metastases, giant cell tumor, or cyst of bone, it should be identified with these diseases; MRI is valuable to diagnosis of spinal hydatid disease; serological examinations are the major method of identification diagnosis; spinal hydatid disease can not be eliminated easily by operation, and often relapses.