脊柱骨软骨瘤的诊断与外科治疗

Diagnosis and surgical treatment of spinal osteochondroma

目的:探讨脊柱骨软骨瘤的诊断及手术治疗效果。方法:1995年1月～2006年6月我院手术治疗脊柱骨软骨瘤患者21例,男14例,女7例,平均年龄35岁(8～61岁)。其中19例为孤立性骨软骨瘤,2例为多发性骨软骨瘤病;病变位于颈椎14例(含颈胸交界段2例),胸椎5例,腰椎2例(含腰骶交界段1例);病变均起自椎弓根、椎板和/或关节突等附件结构。其中15例有神经功能损害,3例仅有局部疼痛或不适,3例为无痛肿物。术前脊髓功能Frankel分级C级1例,D级8例,E级12例。21例均行手术治疗、彻底切除肿瘤。随访观察手术时间、术中出血、术前症状和脊髓功能恢复情况,以及肿瘤复发、恶变和脊柱稳定性情况。结果:平均手术时间130min(45～360min);术中平均出血510ml(20～2000ml)。术后病理诊断均为骨软骨瘤。17例获得随访,平均7.1年(4～14年),术前有脊髓神经功能障碍者均恢复至Frankel E级,末次随访时CT检查均未发现肿瘤复发或恶变。结论:CT和/或MRI检查对诊断脊柱骨软骨瘤有重要意义,手术彻底切除可获得良好效果。

Objective：To evaluate the diagnosis and surgical treatment of spinal osteochondroma.Method：A retrospective review of 21 patients with spinal osteochondroma treated surgically in our hospital from January 1995 to June 2006 was performed.There were 14 males and 7 females with the mean age at diagnosis of 35.0 years old（range,8-61 years old）.19 cases had lesions solitary and 2 multiple.14 lesions were located in the cervical spine,5 in the thoracic spine,and 2 in the lumbar spine;All the lesions had posterior elements involved.15 patients presented with neurologic deficits,3 with local pain or discomfort,and 3 with painless mass.Preoperative Frankel system showed grade C in 1 case,grade D in 8 cases and grade E in 12 cases.All patients underwent surgical procedures.The surgical time,blood loss,preoperative symptoms,tumor recurrence and metastasis,as well as the status of spinal stability were followed-up and reviewed.Result：The mean surgical time was 130mins（range,45-360mins）;the average intraoperative blood loss was 510ml（range,20-2000ml）.All patients had Frankle score improved to grade E after operation.17 cases were followed up for an average of 7.1 years（range,4-14 years）,no tumor recurrence was noted.Conclusion：CT and/or MRI is critical for final diagnosis.Surgery is indicated for long-term neck pain,neurological defect,and/or lesion progression recently.Complete resection of the tumor is reliable.