脊柱骨巨细胞瘤的手术治疗策略

Surgical strategy for spinal giant cell tumor

中文关键词:  脊柱  骨巨细胞瘤  手术

英文关键词:Spine  Giant cell tumor  Surgery

中文摘要:

  【摘要】 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。

英文摘要:

  【Abstract】 Objective：To investigate the surgical strategy for spinal giant cell tumors.Method：41 patients between July 1998 and June 2007 were interviewed retrospectively.There were 20 females and 21 males with the average age of 31 years old（range，17-52 years old）.Cervical，thoracic and lumbar vertebrae were involved in 3，25 and 13 patients respectively.27 patients underwent the primary operation in our hospital，while the other 14 patients were referred to our hospital due to local recurrence.Preoperative segmental artery embolism was performed in 14 patients.Vertebral body involvement was seen in 18 patients and corpectomy and reconstruction by either auto-bone or artificial vertebral body was performed anteriorly.In 16 patients with vertebral body and appendix involvement，combined anterior and posterior approach was used for tumor resection and reconstruction.4 patients with vertebral body and appendix involvement and with no or minor soft tissue involvement underwent spondylectomy en bloc by posterior approach.3 patients with vertebral body and vertebral appendix partial involvement underwent subtotal spondylectomy by posterior approach.Their clinical outcomes were reviewed.Result：The average blood loss for patients undergoing segmental artery embolism was 3100ml，while 4500ml for 27 patients with no segmental artery embolism.Complete tumor resection was not performed in 2 patients due to uncontrolled hemorrhage，as a result，compensatory radiation therapy was given postoperatively，and both of them were still alive till the last follow-up（35 and 29 months respectively）.The other 39 cases were followed up for a mean of 52.9 months.Significantly pain relief was seen in 36 patients.Local recurrence occurred in 16 patients（41%）.Of the 27 patients undergoing the primary operation in our center，9 patients（33.3%） developed local recurrence.11 cases underwent anterior procedure alone，of these，6 cases had recurrence.12 cases underwent combined anterior and posterior procedure，3 cases developed recurrence.4 cases experienced corpectomy en bloc，no recurrence was noted.While as for the 12 cases admitted into our center due to recurrence in other hospital，7 cases（57.1%） developed second recurrence，and 2 cases died of systemic failure.21 patients had been followed up for more than 3 years，and 13 patients had no recurrence.No instrument failure was noted.Conclusion：For spinal giant cell tumor，in order to reduce local recurrence，more aggressive surgery should be considered.