【摘要】 目的:探讨脊柱血管瘤(VH)的诊断和治疗方法。方法:2003年4月～2010年5月,共收治有临床症状的脊柱血管瘤(SVH)患者20例,男性7例,女性13例,年龄21～67岁,平均43.8岁。15例出现神经损害症状,其中脊髓损害12例,神经根损害3例;5例仅有局部疼痛。病灶位于颈椎5例,胸椎12例,腰椎3例。术前经X线片、CT和/或MRI检查,15例诊断明确,5例诊断不明确患者术前在CT引导下穿刺活检。1例单纯疼痛者行椎体成形术,2例单纯疼痛和4例神经损害轻微者行放疗,13例伴严重神经损害、压缩骨折或诊断不明确者行开放手术治疗。结果:5例CT引导下穿刺活检者仅1例病理诊断为血管瘤,1例取活检失败,3例诊断与术后病理诊断不一致。1例单纯疼痛行椎体成形术和2例单纯疼痛行放疗者治疗后疼痛缓解;4例轻微神经损害者放疗后1例神经功能完全恢复,3例无效改行手术治疗后症状缓解;开放手术治疗患者术后神经症状完全缓解。随访3～78个月,平均31.9个月,19例无复发,1例病灶部分切除减压者术后17个月复发,再次行减压、术后放疗,随访15个月未见复发。结论:脊柱血管瘤大多通过影像学检查可明确诊断,术前CT引导下穿刺活检对其确诊率不高。根据患者临床及影像学表现采取不同的治疗方法可取得较好的治疗效果。更多还原

【Abstract】 Objective:To investigate the diagnosis and management of symptomatic vertebral hemangioma(VH).Method:20 patients suffering symptomatic VH were admitted to our hospital between April 2003 and May 2010.There were 7 males and 13 females with the average age of 43.8 years(range,21-67 years).Lesions included 5 in the cervical spine,12 in the thoracic and 3 in the lumbar.15 patients were presented with neurologic deficits(12 myelopathy and 3 radiculopathy),and 5 with local pain alone.After preoperative X-ray,CT scan and/or MRI,15 patients were confirmed,while,and CT guided percutaneous needle biopsy was performed in 5 cases without classical radiographic findings.3 patients with local pain were suggested to undergo radiotherapy or vertebroplasty.4 with mild neurological deficit had radiotherapy.13 cases with severe neurological deficit,compressive fracture secondary to conservative treatment or inexplicit diagnosis underwent surgery.Result:CT guided percutaneous needle biopsy was performed in 5 patients,but only 1 revealed hemangioma,1 had failed biopsy and 3 showed no concordance with the clinical diagnosis.1 patient with local pain had vertebroplasty.6 cases had radiotherapy,but 3 failed and underwent to surgery.A total of 16 cases had surgery finally.20 cases were followed up for an average of 31.9 months(range,3 to 78 months).Only 1 local recurrence was noted 17 months after simple decompression and healed completely and showed no recurrence due to redecompression and radiotherapy.Conclusion:Most of VH can be accurately determined by radiographic examination.CT guided percutaneous needle biopsy had poor diagnostic value.Radiotherapy,vertebroplasty,ethanol injection and operation can be performed individually based on clinical and radiographic findings.更多还原