扩大刮除术治疗脊柱骨巨细胞瘤18例临床报告

Application of extensive curettage in the treatment of giant cell tumors of the spine: a clinical report of 18 cases

目的研究扩大刮除术治疗脊柱骨巨细胞瘤的疗效。方法回顾性分析2006年5月至2012年5月,北京积水潭医院骨肿瘤科收治的具有完整临床病理及随访资料的18例初次诊治的脊柱骨巨细胞瘤病例。其中男8例,女10例,平均年龄31.6岁;患者术前均有不同程度疼痛症状,5例合并脊髓功能受累;病变累及颈椎1例,胸椎9例,腰椎8例。手术方式均采取扩大刮除术,10例行单纯前路手术,3例行单纯后路手术,5例行前后联合入路手术。术后行辅助放疗患者10例,未行放疗患者8例,其中单纯前路手术患者6例,单纯后路手术患者1例,前后联合入路手术患者1例。随访观察治疗效果。结果 18例获中位46（12~83）个月随访。4例复发（22.2%）,平均复发时间34.5（6~71）个月,均为单纯前路手术且术后未行辅助放疗患者。其中3例再次行手术扩大刮除及辅助放疗,1例行单纯放疗。此4例再治疗后平均随访36（12~59）个月,未见复发。术后疼痛消失11例,疼痛缓解7例;5例脊髓功能受累病例均获不同程度改善;1例术后27个月出现椎弓根钉折断。结论单纯扩大刮除术简单、易行,辅以术后放疗可以有效治疗脊柱骨巨细胞瘤,局部复发率并不高于其它治疗方法。

Objective To observe clinical effects of extensive curettage in the treatment of giant cell tumors of the spine. Methods From May 2006 to May 2012, 18 patients diagnosed as giant cell tumors of the spine were retrospectively analyzed, with complete clinicopathologic and follow-up data. There were 8 males and 10 females, with the mean age of 31.6 years old. All patients had preoperative pain symptoms of varying degrees, while 5 patients were combined with spinal cord involvement, 1 with cervical spine, 9 with thoracic spine, 8 with lumbar spine. All received extensive curettage, specifically, simple anterior approach in 10 patients, simple posterior approach in 3 patients, and combined anterior with posterior approach in 5 patients. Ten patients underwent postoperative adjuvant radiotherapy and the other 8 patients did not undergo radiotherapy, among which simple anterior approach in 6 patients, simple posterior approach in 1 patient, and combined anterior with posterior approach in 1 patient. Effects were observed in follow-up. Results The median follow-up time of 18 patients was 46 months（ range： 12-83 months）. There were 4 patients of relapsed（ 22.2%）. The average period of recurrence was 34.5 months（ range： 6-71 months）. They all underwent simply anterior approach without postoperative adjuvant radiotherapy. Wherein, 3 patients underwent extensive curettage and adjuvant radiotherapy again, and 1 patient underwent routine radiotherapy. Wherein, the average follow-up time of above 4 patients were 36 months after re-treatment（ range： 12-59 months）. There was no recurrence. Postoperative pain was disappeared in 11 patients and relieved in 7 patients. Involved functions of the spinal cord in 5 patients received different degrees of improvement. Pedicle screw was broken in 1 patient at 27 months postoperatively. Conclusions Extensive curettage is easier to operate. The local recurrence rate of extensive curettage with postoperative radiotherapy in the treatment of giant cell tumors of the spine is comparable with other methods.