全脊椎切除术治疗脊柱骨母细胞瘤的临床疗效

Clinical efficacy of total spondylectomy in the treatment of spinal osteoblastoma

中文关键词:  脊柱  骨母细胞瘤  全脊椎切除术  影像学评价

英文关键词:Spine  Osteoblastoma  Total spondylectomy  Imaging evaluation

中文摘要:

  【摘要】 目的：探讨全脊椎切除术治疗脊柱骨母细胞瘤的临床疗效，为临床治疗提供参考。方法：回顾性分析2013年1月~2023年1月因胸椎、腰椎骨母细胞瘤于中国人民解放军北部战区总医院行全脊椎切除术治疗的病例12例，其中男性7例，女性5例，年龄33.8±9.4（15~45）岁；胸椎病变8例，腰椎病变4例。所有病例经病理学确诊后，行经后路全脊椎切除、钛网置入、椎弓根螺钉内固定手术，术后给予对症处理及相关检查。统计手术时间、术中出血量及并发症情况，术前和术后分别行Frankel脊髓损伤分级、视觉模拟量表（visual analogue scale，VAS）评分、日本骨科协会（Japanese Orthopaedic Association，JOA）评分及X线、CT、MRI影像学检查等进行功能评价和影像学评价。对连续性变量进行正态分布和方差齐性检验，使用配对t检验对数据进行比较分析，所有统计学分析均使用SPSS软件进行。结果：随访4.7±2.8（2~10）年，随访期间无术后内固定破坏、脊柱畸形、肿瘤复发及死亡病例发生。手术时间4~6.5h（5.5±0.6h）；手术出血量为1200~3080mL（2325.0±616.5mL）。Frankel分级，术后2年时5例患者较术前提高1级，4例提高2级，3例提高3级。VAS评分由术前5~9分降至术后2年时1~4分，差异有统计学意义。术后2年时JOA评分较术前明显改善，改善率达55%~92%。术后2例患者发生切口感染，经局部清创和抗生素治疗后恢复良好；2例出现神经损伤加重，经脱水、抗炎及康复等治疗措施后恢复良好；1例出现坠积性肺炎，1例发生胸腔积液及气胸，经相应治疗后预后较好。术后1个月时10例钛网置入位置准确，内固定装置稳定性良好；2例钛网置入位置略微偏移，但未发生脊柱畸形和内固定破坏。结论：全脊椎切除术在治疗骨母细胞瘤方面具有较高的临床应用价值，能够有效切除肿瘤并减少术后并发症的发生。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical efficacy of total spondylectomy in the treatment of spinal osteoblastoma, in order to provide reference for clinical treatment. Methods: A retrospective analysis was conducted on 12 patients with thoracic and lumbar osteoblastoma underwent total spondylectomy in General Hospital of Northern Theater Command, Chinese People′s Liberation Army from January 2013 to January 2023. There were 7 male patients, 5 female patients, aged 33.8±9.4(15-45) years old, 8 patients with thoracic lesions and 4 patients with lumbar lesions. After pathological diagnosis, all the cases were treated with total spondylectomy, titanium mesh implantation and pedicle screw internal fixation. The operative time, blood loss, and complications were collected and recorded, and Frankel spinal cord injury grade, visual analogue scale(VAS) score, Japanese Orthopaedic Association(JOA) score, X-ray, CT and MRI imaging examinations were performed before and after operation to evaluate the function and imaging findings. The continuous variables were tested for normal distribution and homogeneity of variance, and paired t-test was used for statistical analysis of the data. All statistical analysis was carried out with SPSS software. Results: The patients were followed up for 4.7±2.8(2-10) years. The operative time was 4-6.5h (5.5±0.6h), and the blood loss was 1200-3080mL(2325.0±616.5mL). Frankel grade, 2 years after operation, 5 cases were improved by 1 grade, 4 cases by 2 grades, and 3 cases by 3 grades. The VAS score decreased from 5-9 points before operation to 1-4 points at 2 years after operation, the difference was statistically significant. The postoperative JOA score was significantly better than that before operation, and the improvement rate was 55%-92%. As for complications, incisional infection occurred in 2 cases and recovered well after local debridement and antibiotic treatment; Nerve injury was aggravated in 2 cases and recovered well after treatment such as dehydration, anti-inflammation and rehabilitation; 1 case developed pendant pneumonia, 1 case developed pleural effusion and pneumothorax, and the prognosis was good after corresponding treatment. At 1 month after operation, the placement of titanium mesh was accurate and the stability of internal fixation device was good in 10 cases, and the placement of titanium mesh was slightly shifted in 2 cases, but no spinal deformity and internal fixation failure occurred. Conclusions: Total spondylectomy has high clinical value in the treatment of osteoblastoma, which can effectively remove the tumor and reduce the occurrence of postoperative complications.