脊柱骨母细胞瘤的临床特点与手术治疗

摘要

目的 总结脊柱骨母细胞瘤的临床特点,探讨其手术治疗效果.方法 对2006年6月至2010年7月手术治疗的11例脊柱骨母细胞瘤患者的临床资料进行回顾性总结分析.其中男性7例,女性4例,年龄16～34岁,平均23.5岁.病变部位:C5 3例,C6 4例,C72例,C6～T11例,T111例,根据WBB脊柱原发肿瘤分期系统,累及1～3区或10～12区9例,同时累及1～3区和4～9区2例.9例采用单纯后路肿瘤切除术,2例采用一期前后联合入路肿瘤切除术,8例辅以内固定加植骨融合重建脊柱稳定性.应用视觉模拟评分(VAS)评价手术前后疼痛改变,采用McCormick分级标准评价患者脊髓功能状态.影像学检查评估术后脊柱脊髓情况、有无复发、脊柱稳定性及植骨融合情况.结果 随访12～64个月,平均28.4个月.手术时间90～210 min,平均130.5 min；术中出血300～1000 ml,平均560 ml.VAS评分从术前的6.3±1.1减少到术后3个月的2.5±1.0,差异具有统计学意义(t=8.48,P＜0.05).末次随访时脊髓功能状态按McCormick分级标准评价,好转8例,不变3例.未见肿瘤复发、植入物松动、退出及断裂.结论 脊柱骨母细胞瘤的影像学表现有其特殊性,肿瘤彻底切除、植骨融合及坚强的内固定是手术成功的关键.%Objective To investigate the clinical manifestation and surgical outcome of spinal osteoblastoma.Methods From June 2006 to July 2010,11 patients with spinal osteoblastoma treated surgically were analyzed retrospectively.There were 7 males and 4 females with an average age of 23.5 years (range,16-34 years).The tumors were located at C5 in 3,C6 in 4,C7 in 2,C6～T1 in 1 and T11 in 1.Based on WBB classification,9 were 1-3 or 10-12 and 2 were 4-9 and 1-3.All the operations had been performed with en-bloc resection.The posterior approach was used for 9 patients,and combined posterior and anterior approach was used for 2 patients.Reconstruction using instrumentation and fusion was performed using spinal instrumentation in 8 patients.To evaluate the change of pain before and after the operation by visual analogue scales(VAS),and to assess functional status of the spine by McCormick scale.Imaging test was used to review the stability and recurrence rate of spine cord,and the confluence of graft bones.Results All cases were followed up for 12-64 months(average,28.4 months).The average surgical time was 130.5 minutes(range,90-210 minutes),with the average intraoperative blood loss of 560 ml(range,300-1000 ml).During the follow-up period,the VAS grade reduced from 6.3 ± 1.1 to 2.5 ± 1.0(t =8.48,P ＜ 0.05).There were 8 patients had neurological function improved and 3 remained no change which was evaluated by McCormick scale for spinal function status at final follow-up.Conclusions Spinal osteoblastoma has its own specific radiographic feature.There are some recurrence in simple curettage of tumor lesion.The thoroughly en-bloc resection of tumor or spondylectomy,bone fusion and strong in ter fixation are the key points for successful surgical treatment.