脊柱孤立性浆细胞瘤的诊断与治疗

Diagnosis and management of solitary spine plasmacytoma：a report of 20 cases

中文关键词:  脊柱骨髓瘤  浆细胞瘤  诊断  治疗

英文关键词:Spine  Myeloma  Plasmacytoma  Diagnosis  Treatment

中文摘要:

  【摘要】 目的：探讨脊柱孤立性浆细胞瘤（solitary bone plasmacytoma，SBP）的诊断与治疗效果。方法：1998年1月～2009年9月我院骨科共收治SBP患者20例。其中男性11例，女性9例，平均年龄48.2岁（33～74岁）。病灶位于颈椎7例，胸椎10例，腰椎2例，骶骨1例。19例有局部疼痛，13例伴神经功能损害（脊髓损害11例，神经根损害2例）。14例行CT引导下病灶穿刺活检，13例（92.9%）病理结果为骨髓瘤。治疗首选放疗，当存在严重或进展迅速的神经损害、脊柱不稳定、诊断不明确、保守治疗无效时，选择手术。4例患者未手术而行放射治疗（放疗），16例行手术治疗（13例辅以放疗，其中2例术前放疗，10例术后即放疗，1例局部复发后再放疗）。20例中12例化疗，其中10例进展为多发性骨髓瘤（multiple myeloma，MM）之前即化疗，另外2例进展为MM之后才行化疗。结果：全部患者均获得随访，平均49.3个月（12～113个月）。经手术或放疗后局部疼痛均有缓解，其中6例完全缓解。13例有神经损害者，11例手术，存活10例，其中8例Frankel分级由D级改善为E级，2例仍为D级；2例放疗，神经功能1例B级改善至D级，1例仍为D级。首选放疗者6例（包括4例单纯放疗而未手术者和2例放疗无效后手术者），均无局部复发，其中3例病灶重新钙化；2例因骨质破坏无好转，转为手术治疗；另外1例进展为MM死亡。10例术后即放疗者，均无局部复发；而手术后未立即放疗者4例，1例（25%）局部复发。行早期辅助化疗的10例患者中3例（30%）进展为MM，未行早期辅助化疗者10例中4例（40%）进展为MM。结论：CT引导下骨髓穿刺活检是诊断SBP的重要手段；手术与放疗均可达到控制疼痛、缓解脊髓压迫的目的。在未进展为MM之前，辅助化疗的意义仍未明确。

英文摘要:

  【Abstract】 Objective：To investigate the diagnosis and management of solitary bone plasmacytoma（SBP）.Method：Between January 1998 and September 2009，20 patients with SBP undergoing surgery in Orthopaedic Department of Peking University Third Hospital were reviewed retreospectively.There were 11 males and 9 females，with the average age of 48.2 years old （33-74 years）.7 cases had lesions in cervical vertebrae，10 in thoracic，2 in lumbar and 1 in sacrum.19 cases presented with pain and 13 with neurologic deficits（11 myelopathy and 2 radiculopathy）.CT guided percutaneous biopsy was performed in 14 patients，13（92.9%） of which was myeloma.The first-choice treatment was radiotherapy，and surgery was indicated when severe or progressed neurologic deficits，spinal instability，unclear diagnosis and no response to radiotherapy.4 patients received radiotherapy alone，while surgery was performed in 16 cases（including 13 cases with combined radiotherapy，of these，2 patients underwent radiotherapy before surgery，10 immediately after surgery，and 1 after local recurrence）.12 cases received supplementary chemotherapy，10 when confirmation of diagnosis and 2 when progression to multiple myeloma（MM）.Result：All patients were followed up for an average of 49.3 months （range，12 to 113）.Pain relief was achieved in all cases and 6 had completely pain relief.11 of 13 cases with neurologic deficit and with Frankel D received surgery，of these，10 were still alive with neurologic function improved significantly，while 8 of them progressed to Frankel E.The other 2 cases received radiotherapy，of these，1 case with Frankel B progressed to Frankel D，and 1 Frankel D had neurofunction improved despite Frankel score remained unchanged.No local recurrence was observed in the 6 cases undergoing radiotherapy，and recalcification was seen in 3 of them，and 1 case progressed to MM and died.No local recurrence was found in 10 patients undergoing radiotherapy immediately after surgery，while recurrence was noted in 4 cases undergoing operation and no radiotherapy.3 of the 10 patients experiencing adjuvant chemotherapy progressed to MM，while of the other 10 patients，40% progressed MM.Conclusion：CT guided needle biopsy is valuable for determination of SBP.Pain relief and neurological resolution can be achieved by both surgery and radiotherapy.Recalcification is evidenced in some cases after radiotherapy.The mechanism of adjuvant chemotherapy remains unclear before progression to MM.