症状性脊椎血管瘤的术式选择和疗效分析

Options and surgical outcomes of symptomatic vertebral hemangiomas

中文关键词:  血管瘤  脊椎  经皮椎体成形术  开放手术

英文关键词:Hemangioma  Spine  Percutaneous vertebroplasty  Open surgery

中文摘要:

  【摘要】 目的：探讨症状性脊椎血管瘤手术治疗方式选择，评价手术治疗效果。方法：1998年7月~2013年6月北京大学人民医院骨与软组织肿瘤中心收治并获得随访的症状性脊椎血管瘤患者49例，男19例，女30例。年龄16～83岁。术前均有与血管瘤相关的局部疼痛或脊髓神经根受压症状；其中16例伴有脊髓神经功能损伤（Frankel分级为B～D级）。18例椎体后壁完整、无硬膜囊或神经根受压和/或脊柱不稳的患者行经皮椎体成形术，31例椎体后壁不完整、存在硬膜囊或神经根受压和/或脊柱不稳的患者行开放手术。分析评估所有患者手术后的脊髓功能改善情况、并发症及疼痛症状缓解情况（VAS评分）。结果：18例行经皮椎体成形术者未发生围手术期并发症；术后24h VAS评分由术前4.2±1.6分（2~8分）降至1.0±1.2（0~4分）（P<0.01）；随访58.7±34.3个月（14~127个月），16例无症状复发，2例症状复发并加重，经放疗后缓解。31例行开放手术者经后路手术19例，前路手术7例，前后路联合手术5例；术中出血量2270±1702ml（300~6000ml）；术中1例出血量大，未行内固定术，其余30例均行内固定术，术后发生局部血肿2例，伤口感染1例，无围手术期死亡病例；术后3个月，16例伴不完全截瘫患者14例脊髓功能改善1级或以上，15例术前存在局部疼痛或神经根刺激的患者VAS评分由术前4.8±2.0分（3~9分）降至1.3±1.7分（0~6分）（P<0.01）；1例术后半年死于其他疾病，其余30例随访76.3±42.1个月（14~191个月），4例复发，其中2例无症状，给予观察，1例有症状者放疗后缓解，另1例手术后缓解。结论：对症状性脊椎血管瘤手术治疗能够取得良好临床疗效。对于椎体后壁完整、无硬膜囊或神经根受压和/或脊柱不稳的患者采用经皮椎体成形术可取得较好果；而对于椎体后壁不完整、存在硬膜囊或神经根受压和/或脊柱不稳的患者应行开放手术治疗。

英文摘要:

  【Abstract】 Objectives: To investigate the indications of symptomatic vertebral hemangiomas(SVH), and to evaluate the surgical outcomes. Methods: Between July 1998 and June 2013, 49 SVHs were operated in the musculoskeletal tumor center of Peking University People′s Hospital. There were 19 males and 30 females. The average age was 53 years(range, 16-83 years). All patients presented with unremitted pain or neurological deficit(Frankel B-D). For patients with posterior vertebral body wall intact and no sign of spinal instability or neurological deficit, percutaneous vertebroplasty(PVP) was performed(18 patients). Otherwise, open surgery was performed(31 patients). Preoperative and postoperative spinal cord function(Frankel scale), complications and pain(visual analogue scale, VAS) were analyzed respectively. Results: All 18 patients undergoing PVP had no perioperative complication and the average VAS score decreased from 4.4(2-8) to 1.0(0-4)（P<0.01）. After follow-up of 59 months(range, 14-127 months), 2 patients suffered from pain relapse which was relieved by radiotherapy. Among 31 patients who underwent open surgeries, posterior approach, anterior approach, and posterior-anterior combined approach were used in 19, 7 and 5 patients respectively. The average blood loss during operation was 2270ml(range, 300-6000ml). Except for 1 patient who suffered from massive intraoperative hemorrhage and unavailable for instrumentation, 30 patients underwent internal fixation. Two patients suffered from local hematoma and one had skin incision infection. No perioperative death was observed. 3 months after the operation, 14 of the 16 patients presented with an improved Frankel grade. Among the 15 patients with local pain or neurofunction deficit, the average VAS decreased from 4.8(3-9) to 1.3(0-6)（P<0.01）. After a mean follow-up of 76.3 months(range, 14-191 months), 4 patients had local recurrence, 2 cases without symptom were followed up simply, and the other 2 with symptoms were treated successfully with surgery or radiotherapy. Conclusions: For SVH, operative treatment can achieve good clinical curative effect. Open surgery should be considered for those with posterior vertebral body wall broken, huge paravertebral soft tissue mass, compressed dura sac or spinal nerve, and/or spine instability caused by pathologic fracture, otherwise, PVP is a better option.