【摘要】 目的探讨脊柱骨母细胞瘤的临床特点、治疗方法及预后。方法回顾性分析2001年7月至2009年7月本院收治的12例脊柱骨母细胞瘤患者的临床表现、诊断和治疗方法。结果其中男4例,女8例;中位年龄21岁(9～63岁)。累及颈椎1例,胸椎4例,腰椎3例,胸腰段1例,骶椎3例。均有疼痛,伴有神经损伤症状6例,伴有脊柱侧凸4例,1例患者存在肿块,1例存在脊髓压迫。7例为复发病例或术前活检明确诊断,4例患者术前影像学表现典型,考虑为骨母细胞瘤,其中1例误诊为骨肉瘤。所有患者均行手术治疗,根据肿瘤部位不同采取前路、后路或前后路联合肿瘤切除,并予以相应方式重建。手术时间平均3.3h(1.5-6.5h)。出血量平均1975ml(300～4500ml)。术后疼痛和神经根损害表现均消失,3例脊柱侧弯患者畸形得到纠正,2例患者4次出现脑脊液漏,经应用抗生素和床尾抬高治疗后愈合。10例随访平均4年(1-8年),2例分别于术后3个月、2年6个月复发,其余均无疼痛症状,未见肿瘤复发。结论脊柱骨母细胞瘤临床特征复杂,临床表现、影像学检查结合穿刺病理有助于确诊。根据不同的肿瘤部位,采取不同的手术入路行彻底的切除肿瘤能够取得良好效果。更多还原

【Abstract】 Objective To discuss the clinical charactistics,treatment and prognosis of spinal osteoblastoma. Methods From July 2001 to July 2009,the clinical manifestations,diagnosis and treatment of 12 patients with spinal osteoblastoma were retrospectively reviewed.Results 4 males and 8 females aged from 9 to 63 were analyzed.The mean age was 21 years.Cervical vertebrae was involved in 1 case.Thoracic vertebrae was involved in 4 cases.Lumbar vertebrae was involved in 3 cases.Thoracolumbar segment was involved in 1 case.Sacral vertebrae was involved in 3 cases.Pain existed in all patients.Accompanied neurotrosis existed in 6 patients.Scoliosis existed in 4 patients.Lump existed in 1 patient.Spinal cord compression existed in 1 patient.7 patients were reactiation cases or diagnosed clearly and definitely by preoperative biopsy.4 patients were typical in preoperative imaging,who were concerned as patients with osteoblastoma.1 patient was misdiagnosed as patient with osteosarcoma.All patients underwent surgical treatment. According to the tumor location,anterior approach,posterior approach or combined anterior-posterior approach surgery was applied to remove the tumor.Stability was reconstructed in separate ways.The mean operation duration was 3.3 hours(range,1.5-6.5 hours),and the average intraoperative blood loss was 1975ml(range,300-4500ml).All patients were relieved from pain and neurological defect after surgery.Scoliosis in 3 cases was corrected.Cerebrospinal fluid leakage appcared in 2 patients for 4 times,which was successfully cured with antibiotics and foot-up leaning position. The mean follow-up period of 10 patients was 4 years(range,1-8 years).Recurrence occurred in 1 case 3 months after the surgery and 1 case 30 months after the surgery respectively.Other cases were all relieved from pain and no evidence of local recurrence existed.Conclusions The clinical features of spinal osteoblastoma are complex.Clinical manifestations,imaging features and needle biopsy could be performed conjointly to confirm the diagnosis.According to the tumor location,aggressive resection with different surgical approaches can achieve good result for spinal osteoblastoma.更多还原