症状性椎体血管瘤的外科治疗

Surgical therapy for symptomatic vertebral hemangioma

目的:探讨症状性椎体血管瘤通过多途径外科治疗的适应证及效果。方法:症状性胸段椎体血管瘤患者8例,男6例,女2例。表现为单纯疼痛的2例患者行经皮穿刺椎体成形术;表现为脊髓压迫的6例患者根据压迫部位的不同分别采用:1)前方经胸腔椎体切除+内固定2例;2)后方减压+椎体内骨水泥注射3例;3)后方减压+椎体内骨水泥注射+后方内固定1例。6例有脊髓压迫患者中5例手术前行脊髓血管造影,4例成功栓塞。结果:随访4￣40个月,平均14个月,表现为局部疼痛的2例患者术后第1d症状即完全缓解;脊髓压迫的6例患者术后早期恢复不明显,但无加重,随访期间,除1例手术前即已经完全截瘫的患者外,其余5例患者的运动功能障碍均完全恢复正常。5例患者在随访期间行MRI检查,未见肿瘤复发。结论:症状性椎体血管瘤应根据不同症状选择不同的手术方式,以改善症状为主,而不是强求肿瘤全切。

Objective：To report the results of symptomatic vertebral hemangioma treated by multiple surgical approaches,and to discuss their indications.Method：Eight patients with symptomatic vertebral hemangioma in thoracic region were reviewed.Percutaneous vertebroplasty was performed on 2 patients who complained of only local pain.For 6 patients suffered from spinal cord compression,a variety of surgical techniques was selected based on the compressive site,anterior transthoracic vertebreetomy ＋ fixation in 2 cases,posterior decompression ＋ vertebral body intralesional injection of bone cement in 3 cases,posterior decompression ＋ vertebral body intralesional injection of bone cement ＋ posterior internal fixation in 1 case.5 of 6 patients underwent preoperative spinal angiography,and feeding arteries of the lesion were successfully embolized in 4 patients. Result：Follow up ranged 4 to 40 months,mean 14 months.For 2 patients complained of local pain,the symptom disappeared in the first postoperative day,and no recurrence occured during the follow up.For 6 patients of spinal cord compression,the motor deficit completely resolved during follow up,except one who had already been complete paraplegic before the surgery.But all in the early phase,the deficit did not improve markedly. MRI was performed in 5 patients,and did not show recurrence of the hemangioma,nor the spinal cord compression.Conclusion：Therapeutic purpose of symptomatic vertebral hemangioma is not only total resection of the lesion,but to improve the symptoms using multiple surgical approaches in light of different symptoms.