活动脊柱骨巨细胞瘤的外科治疗

Surgical treatment of the mobile spinal giant cell tumors

目的分析活动脊柱骨巨细胞瘤（giant cell tumor,GCT）手术预后相关的因素,探讨活动脊柱GCT的外科治疗相关的综合治疗策略。方法回顾性分析2002年1月至2013年12月,我院收治120例脊柱GCT病例,其中男42例,女78例,年龄11~65岁,平均（33.7±11.7）岁;外院手术复发后来我院就诊38例,首次来我院就诊82例;颈椎38例（31.7%）,胸椎58例（48.3%）,腰椎24例（20.0%）。分析患者的肿瘤位置、Enneking分级、术前选择性动脉栓塞、手术方式、术后放射治疗、双膦酸盐治疗等6项临床指标与术后肿瘤复发的关系。结果本组120例中,66例接受次全椎节切除术（subtotal spondylectomy,STS）治疗,54例接受全椎节切除术（total spondylectomy,TS）治疗,其中行en bloc全椎节切除术（total en bloc spondylectomy,TES）20例。随访3~84个月,平均（43.9±26.3）个月。术后复发29例,23例首次复发时间在术后2年内。STS、分块全椎节切除术及TES术后肿瘤复发率分别为33.3%、11.1%、5.0%。29例复发病例中,22例采用STS,7例采用TS,复发率分别为33.3%和13.0%,差异有统计学意义（P〈0.05）。结论手术方式是影响活动脊柱GCT复发的重要因素。TS尤其是肿瘤TES能显著降低局部复发率。

Objective To explore key prognostic factors associating with giant cell tumor（ GCT） recurrence and discuss the comprehensive strategies in the treatment of mobile spinal GCT. Methods One hundred and twenty patients of mobile spine GCT were treated in Changzheng Hospital from January 2002 to December 2013. There were 42 males and 78 females with the mean age of（ 33.7 ± 11.7） years（ range： 11- 65 years）. Thirty-eight cases were admitted in our hospital after postoperative recurrence, and 82 cases were of the first diagnosis. There were 38 cases（ 31.7%） in the cervical spine, 58 cases（ 48.3%） in the thoracic spine, and 24 cases（ 20.0%） in the lumbar spine. Clinical parameters such as tumor location, Enneking grading, preoperative selective arterial embolization, surgical approach, postoperative radiotherapy, and bisphosphonate therapy were analyzed to explore the relations with tumor recurrence. Results In 120 cases, 66 cases accepted vertebra corpectomy and 54 cases received total spondylectomy, among whom 20 cases received total enbloc spondylectomy（ TES）. Follow-up lasted for 3 to 84 months with the average of（ 43.9 ± 26.3） months. Recurrence occurred in 29 cases, while 23 patients relapsed within the first 2 years after the surgery. Recurrence rates were 33.3% in the corpectomy group, 11.1% in the piecemeal total spondylectomy group and 5% in the TES group. In 29 relapsed cases, 22 cases were of vertebra corpectomy and 7 cases were of total spondylectomy with the recurrence rates of 33.3% and 13.0% respectively. Differences were statistically significant（ P〈0.05）. Conclusions Surgical method significantly affects the progrosis of mobile spinal GCT. TES with systematic radiotherapy and postoperative bisphosphonate treatment can reduce local recurrence.