儿童脊柱良性肿瘤手术治疗22例随访报告

Preliminary investigation on the clinical effects and surgical methods for children's benign tumors in the spine

目的基于成人脊柱良性肿瘤手术治疗经验,探索儿童脊柱良性肿瘤的手术治疗方法及其疗效。方法回顾性分析我院2009年5月至2015年5月收治的接受手术治疗的儿童脊柱良性肿瘤患者22例,男13例,女9例;年龄2~14岁,平均(9.2±3.7)岁。颈椎5例,胸椎6例,腰椎9例,胸腰椎多发2例。其中前路(3例)采取颈椎椎体次全切,植骨融合内固定术,后路(19例)采取刮除植骨内固定手术,对于椎体肿瘤注意尽量保留病椎上下终板,保留骨骺。结果本组病例无失访,随访1~5年,平均(3.1±1.2)年;除1例出现复发,其余患者术后局部疼痛症状在术后2周内明显好转,VAS疼痛评分由术前的(5.8±1.2)分下降至术后2周时的(1.7±0.8)分(P<0.05);患者术后神经功能均有不同程度改善,其中神经功能Frankel分级2例由C级恢复至E级,10例由D级恢复至E级,其余患儿无神经功能障碍。其中并发扁平椎改变患儿8例,病变椎体高度由术前(0.5±0.1)cm到术后1年增加到(1.2±0.3)cm(P<0.05)。结论在儿童脊柱良性肿瘤切刮除手术治疗中,如果能对脊柱椎体骨骺进行一定的保留,同时仅行有限节段的脊柱融合治疗,内固定的早期取出,都有利于减少手术对儿童脊柱生长发育的影响。

Objective To investigate the clinical effects and surgical methods of treating children’s benign tumors in the spine based on the experience of operating on adult spinal tumors. Methods From May 2009 to May 2015, 22 patients （ 13 boys and 9 girls, aged from 2 - 14 years and average age 9.2 ± 3.7 years ） who had benign tumors in the spine （ cervical vertebra 5, thoracic vertebra 6, lumbar vertebra 9 and thoracolumbar vertebra 2 ） received surgery. Three patients had corpectomy and the spinal fusion was achieved. Nineteen patients achieved debridement and fusion with internal fixation. All endplates and epiphyses were saved. Results After follow-up for 1 to 5 years （ 3.1 ± 1.2 years on average ）, the local pain were significantly improved at 2 weeks after operation except 1 patient, VAS points decreased from 5.8 ± 1.2 to 1.7 ± 0.8 P 〈 0.05. Neural function also improved and no one had neurological dysfunctions. Frankel level was from C to E （ 2 patients ）, D to E （ 10 patients ） and 8 of them had complication of vertebral plana. The height of vertebra had increased from （ 0.5 ± 0.1 ） cm to （ 1.2 ± 0.3 ） cm after surgery P 〈 0.05. Conclusions In the operation for children’s benign tumors in the spine, saving spinal epiphysis, spinal fusion within certain vertebra and internal fixation early all can reduce the negative impact of surgery on the growth of children’s spine.