儿童及青少年脊柱肿瘤

Clinical characters and treatments of children and adolescent spinal bone tumors

目的探讨儿童及青少年脊柱肿瘤的临床特点、治疗方法及预后。方法对1987年1月～2002年6月间收治的43例儿童及青少年脊柱肿瘤患者进行回顾性分析,男31例,女12例;年龄3～16岁,平均11.8岁。瘤样病变11例(占25.6%),良性肿瘤13例(占30.2%),恶性肿瘤19例(占44.2%)。根据发病部位可分为颈椎15例,胸椎16例,腰椎6例,骶椎6例。除1例胸椎恶性淋巴瘤患者采取化疗外,其他患者均行手术治疗,根据病情的不同予以植骨融合或植骨融合内固定,所有恶性肿瘤患者术后均接受放疗或化疗。结果随访时间为1～10年,平均4.3年。良性肿瘤及瘤样病变患者术后疗效较满意,所有患者的局部疼痛和神经症状均有所好转,未出现病变复发、恶变;恶性肿瘤患者中有6例(原始神经外胚层瘤2例、Ewing瘤1例、神经母细胞瘤1例、浆细胞瘤1例、软骨肉瘤1例)因肿瘤转移、全身衰竭死亡,占总数的14.0%、恶性肿瘤的31.6%。1例骨巨细胞瘤、1例恶性神经鞘瘤分别于术后2.5年及10个月局部复发。1例FrankelA级和1例B级患者术后无明显改变,其余均有不同程度改善;3例由C级恢复至D级;8例由D级恢复至E级。结论儿童及青少年脊柱肿瘤中,良性肿瘤如果切除彻底,预后良好;恶性肿瘤治疗效果相对欠佳,有较高的复发及死亡率,其预后与肿瘤的性质。

Objective To study the clinical features, treatment strategy and prognosis of children and adolescent with spinal bone tumors. Methods Forty-three patients were retrospectively investigated from January 1987 to June 2002, thirty-one of which were male, and the others were female. The age of patients ranged from 3 to 16 years with an average of 11.8 years. The pathological examination suggested that tumor-like conditions were 11 cases (25.6%), benign tumors 13 cases (30.2%), and malignant tumors 19 cases (44.2%). The cervical vertebrae tumors were 15 cases, thoracic vertebrae 16 cases, lumbar vertebrae 6 cases, and sacral vertebrae 6 cases. Treatment included: 1 case of malignant lymphoma was only subjected to chemotherapy; and the others were undertaken tumor resection and bone grafting to fusion with or without internal fixation. All patients of malignant tumors were performed adjuvant radiotherapy or chemotherapy after operation. Results The follow-up period was from 1 to 10 years with an average of 4.3 years. All patients of benign tumors obtained satisfied outcomes with local symptom and neural deficits improved, and no tumor recurrence happened. 6 cases (2 cases of primitive neural ectodermal tumor, 1 case of Ewing's sarcoma, 1 case of neuroblastoma, 1 case of plasma cell sarcoma and 1 case of chondrosarcoma) of malignant patients were died from metastasis and systemic failure, and the ratio was 14% and 31.6% of total and malignant tumor respectively. One case of bone giant cell tumor and 1 case of Schwannoma got recurrence at 2.5 years and 10 months after operation respectively. Conclusion For patients of children and adolescent with spinal bone tumors, the prognosis of the benign is better if tumors were removed radically. However, the patients with malignant tumors had worse prognosis with higher recurrent or death rate, and its prognosis is closely correlated to tumor's characters, operation strategy, and extending postoperative therapy.