寰枢椎骨样骨瘤治疗初探

Osteoid osteoma of the atlantoaxial spine: primary observation of the clinical treatment

中文关键词:  骨样骨瘤  寰枢椎  治疗  手术  非甾体抗炎药

英文关键词:Osteoid osteoma  Atlantoaxial spine  Treatment  Surgery  Nonsteroid anti-inflammatory drugs

中文摘要:

  【摘要】 目的：探讨寰枢椎骨样骨瘤的治疗方法及初步疗效。方法：回顾性分析我院2000年~2011年收治的5例寰枢椎骨样骨瘤患者，男3例，女2例，年龄6~22岁，平均12.2岁。患者均有颈痛，VAS评分7~8分，平均7.8分，夜间加重，口服非甾体抗炎药（NSAIDs）症状可缓解。均无神经损害体征，4例有斜颈畸形。核素骨扫描均显示寰枢椎代谢活跃灶；CT显示2例病灶位于寰椎侧块，3例位于齿状突，瘤巢最大直径为10~15mm,平均11.8mm。4例患者经NSAIDs药物治疗半年以上，1例患者疗效满意继续药物治疗；3例患者半年后颈痛复发，其中2例患者伴斜颈畸形，增加药物剂量及服药次数均不能有效缓解症状，行开窗瘤巢刮除、植骨融合术，手术入路分别为经口、右颌下及后路，术后继续NSAIDs治疗。另1例患者因继发寰枢关节脱位就诊，行后路复位枕颈内固定融合术，未切除肿瘤，术后接受NSAIDs治疗。结果：3例开窗瘤巢刮除手术平均耗时110min，平均出血量40ml，手术后病理证实为骨样骨瘤，术后患者均继续口服NSAIDs治疗，平均随访21.6个月，颈痛均缓解，VAS评分平均1.6分，斜颈得到纠正，无相关并发症；随访期间复查CT未见肿瘤复发或进展，其中1例患者术后继续药物治疗1年后停药，随访26个月症状无复发。2例保守治疗患者症状缓解满意，1例随访期间无进展，1例6个月时复查CT可见瘤巢硬化表现。结论：寰枢椎骨样骨瘤少见，NSAIDs治疗短期内疗效肯定，应首先考虑；对于药物疗效欠佳或出现继发损害的患者，应采取开窗瘤巢刮除植骨术，术后继续应用NSAIDs药物治疗可取得较好效果。

英文摘要:

  【Abstract】 Objectives: To discuss the treatment and the clinical effect of the osteoid osteoma of the atlantoaxial spine. Methods: A retrospective review of 5 patients with the atlantoaxial osteoid osteoma admitted in our hospital between 2000 and 2011. There were 3 males and 2 females, with a mean age of 12.2 years(from 6 to 22 years old). All patients complained neck pain with constant nocturnal severe pain, and VAS ranged from 7 to 8, averaging 7.8. The NSAIDs tests were positive. 4 patients presented with marked torticollis. No one had neurological defect. Bone scan was positive in all patients. Computed tomography confirmed the location of lesions: C1 lateral mass was involved in 2 cases, 3 were located in the dense axis. The maximal diameter of the nidus was from 10 to 15mm, with an average of 11.8mm. 4 patients received NSAIDs drug therapy for at least six months, 3 of them achieved intralesionally curettage because of the poor response to the conservative treatment, and only one patient maintained drug therapy. The patient with atlantoaxial dislocation secondary to C1 lateral mass lesion accepted a posterior reduction surgery, and tumor curettage was not performed. All the patients received the post-operative medicine cure with NSAIDs drug. Results: The surgery took 110min in average, and the average blood loss was 40ml. Symptoms were relieved immediately after surgery, and torticollis was corrected. No surgery related complications occurred. There was no symptom recurrence or tumor progress during the follow-up(mean time 21.6 months). One patient stopped drug therapy 1 year after surgery without symptom recurrence. The nidus sclerosis was found in 2 patients who accepted conservative therapy. Conclusions: The osteoid osteoma of the atlantoaxial spine is less common. Intralesionally curettage operation should be selected for cases with poor response to the conservative treatment or with secondary damage. Surgical removal is selected for the appropriate cases. It is better to keep using NSAIDs therapy after operation.