症状性椎体血管瘤影像学表现及手术治疗

Imaging appearance and surgical management for symptomatic vertebral hemangioma

中文关键词:  椎体血管瘤  椎体成形术  手术治疗

英文关键词:Vertebral hemangioma  Vertebroplasty  Surgical treatment

中文摘要:

  【摘要】 目的：探讨症状性椎体血管瘤的影像学表现、手术治疗方法及疗效。方法：回顾2006年5月～2012年5月收治的17例椎体血管瘤病例，其中男5例，女12例，年龄27～68岁，平均47.1岁。累及椎体共计18个节段，胸椎7个节段，腰椎11个节段。临床症状主要以疼痛为主，占77.8%（13/17）；伴随神经损害者占22.2%（4/17），Frankel分级2例C级，2例D级；病程8～36个月。影像学上病灶局限于椎体内且仅有疼痛症状者13例，单纯行椎体成形术；呈膨胀性生长合并根性症状者2例，行椎板切除减压辅以术中椎体成形术；累及全椎体伴随严重脊髓压迫者2例，行全椎体切除重建，在行椎体切除之前对所切椎体均行椎体成形处理。应用VAS评分及SF-36量表评价患者疼痛及生活质量，随访观察治疗效果。结果：本组平均手术时间95min，术中平均失血量265ml，术后2周内下地自主活动，病理证实海绵状血管瘤15例，毛细血管瘤2例。所有病例均得到随访，随访时间4～60个月，平均28.2个月，术后疼痛症状均得到有效缓解，无需额外服用镇痛药物，术前VAS及SF-36评分分别为7.6±1.3分和45.2±5.4分，末次随访时分别为1.4±0.8分和89.3±7.2分，与术前比较均有显著性差异（P＜0.05）。2例术前Frankel C级患者及2例D级患者于术后神经功能均恢复至Frankel E级，平均恢复时间5.4个月。影像学随访未发现肿瘤复发、假关节形成或内固定移位松动。结论：对于不同症状和影像学表现的症状性椎体血管瘤，采取不同的手术方式可以取得良好的效果，椎体成形术可以单独使用也可以联合其他术式治疗症状性椎体血管瘤，效果良好。

英文摘要:

  【Abstract】 Objectives: To investigate the imaging appearance, surgical management and the outcome for symptomatic vertebral hemangioma. Methods: 17 cases(5 males and 12 females) suffering from symptomatic vertebral hemangioma with an average age of 47.1 years(range, 27-68 years) were observed from May 2006 to May 2012. There were 18 vertebrae involved in this group. 7 cases had defect sited in thoracic and 11 in lumbar. Pain was the major complain of these cases(77.8%, 13/17), 4 cases had neurological deficit(22.2%) which included 2 Frankel C and 2 Frankel D. The disease course in this group was 8 months to 36 months. Cases suffering from pain and having defect locating in vertebral body(13 cases) underwent percutaneous vertebroplasty(PVP), while those with radiculopathy and having defect penetrating the vertebral wall(2 cases) underwent laminectomy plus intraoperative vertebroplasty, vertebrectomy and reconstruction combined with intraoperative vertebroplasty was performed on aggressive cases with circumferential compression and posterior elements involved(2 cases). The VAS scale and SF-36 scale were applied in patients for evaluating pain and quality of life at follow-up. Results: The mean operation time and blood loss was 95min and 265ml respectively. All patients started to walk within 2 weeks after surgery. Pathological finding confirmed 15 cavernous hemangiomas and 2 capillary hemangiomas. The mean follow-up was 28.2 months(range, 4-60 months). All cases got satisfied pain relief and could live free of analgesics. There was significant difference in postoperative VAS and SF-36(1.4±0.8 and 89.3±7.2) compared with preoperative ones(7.6±1.3 and 45.2±5.4). 4 patients with neurological deficit got good recovery from Frankel C or D to Frankel E, with a mean recovery time of 5.4 months. No recurrence, instrument failure, and pseudarthrosis were observed in this group. Conclusions: The surgical management and its outcome of symptomatic vertebral hemangioma depend on the imaging finding and clinical symptom, which can be managed by vertebroplasty alone or combination with other intervention.