论文部分内容阅读
目的:探讨脊柱骨巨细胞瘤合理的手术治疗策略。方法:回顾性分析1998年7月至2007年6月我科收治的41例良性脊柱骨巨细胞瘤患者的临床资料,男21例,女20例,平均年龄31岁。初次手术27例,外院治疗后复发14例。患者均有不同程度疼痛症状。病变累及颈椎3例,胸椎25例,腰椎13例。14例患者术前行动脉造影,同时栓塞肿瘤节段血管。18例肿瘤只累及椎体的患者采用经前路肿瘤切除椎管减压术,前路植自体骨或人工椎体重建切除的椎体,并应用钢板螺钉固定;16例病灶同时累及椎体及附件的患者采用前后联合入路,术中先行椎管后路减压,切除附件内肿物,并应用椎弓根钉行内固定术,后行前路椎体肿瘤切除手术;4例患者一般情况较好,肿瘤只破坏1～2个脊椎、没有明显的软组织肿块,行一期后路全脊椎切除术;3例椎体部分受累的患者行后路次全脊椎切除术。随访观察治疗效果。结果:行节段动脉栓塞组14例,平均出血约3100ml;未栓塞组27例,平均出血量约4500ml。2例复发的患者最终未能彻底切除肿瘤,术后行放疗,分别随访35及29个月,荷瘤生存。其余39例患者中,36例(92.3%)术后疼痛得到明显缓解;术后平均随访52.9个月,16例复发(41.0%)。初治的27例患者9例复发(33.3%),其中单纯前路手术11例,复发6例;前后路联合手术12例,复发3例;全脊椎切除术4例,未见复发。12例外院复发病例7例再次复发(57.1%),其中2例因肿瘤发展,全身衰竭死亡。21例随访3年以上,其中13例未见复发。所有病例均未见内固定松动、移位或折断。结论:对于脊柱骨巨细胞瘤,首次治疗选择较为彻底的手术方案是降低复发率的关键。
Objective: To explore the reasonable surgical treatment of giant cell tumor of the spine. Methods: The clinical data of 41 patients with giant cell tumor of benign bone in our department from July 1998 to June 2007 were retrospectively analyzed. There were 21 males and 20 females, with an average age of 31 years. The first operation in 27 cases, the hospital recurred in 14 cases after treatment. Patients have varying degrees of pain symptoms. Lesions involving the cervical spine in 3 cases, 25 cases of thoracic spine, 13 cases of lumbar spine. Fourteen patients underwent preoperative arterial angiography and embolization of tumor segments. 18 cases of tumor involving the vertebral body in patients with anterior resection of the spinal canal decompression, anterior autologous bone or artificial vertebral reconstruction of vertebral body, and the use of plate fixation; 16 lesions involving the vertebral body and Annex patients before and after the combined approach, intraoperative spinal decompression, resection of the tumor, and pedicle screw fixation, anterior vertebral body tumor resection surgery; 4 patients in general Better, the tumor destroyed only 1 to 2 spines, no obvious soft tissue mass, a line of posterior total spondylectomy; 3 cases of vertebral body partial involvement of patients underwent subtotal subtotal splenectomy. Follow-up observation of the therapeutic effect. Results: There were 14 cases of arterial embolism in the segment, with an average bleeding of 3100ml. In the non-embolized group, 27 cases had an average bleeding of 4500ml. Two patients relapsed eventually failed to completely remove the tumor. Postoperative radiotherapy was followed up for 35 and 29 months, respectively. The rest 39 patients, 36 (92.3%) postoperative pain were significantly relieved; average follow-up was 52.9 months, 16 cases of recurrence (41.0%). Among the 27 newly diagnosed patients, 9 cases were relapsed (33.3%), of which 11 cases were anterior resection alone and 6 cases were recurrence; 12 cases were combined with anterior and posterior approach and 3 cases were relapsed; 4 cases were treated with total spondylectomy without recurrence. Seven out of 12 cases of recurrent outpatient relapse (57.1%), of which 2 cases died of systemic tumor due to tumor development. 21 cases were followed up for more than 3 years, of which 13 cases no recurrence. No cases of internal fixation loose, displaced or broken. Conclusion: The first choice of surgical treatment of giant cell tumor of the spine is the key to reduce the recurrence rate.