脊柱良性与侵袭骨母细胞瘤临床及影像对比研究

Clinical, imaging characteristics of benign and aggressive spinal osteoblastoma

目的 比较脊柱良性和侵袭性骨母细胞瘤的临床、影像表现,以提高临床诊断水平.方法 回顾性分析2004年5月至2015年11月间所有经临床病理证实的17例良性（BO）和18例侵袭性脊柱骨母细胞瘤（AO）的临床、影像资料.其中34例行CT检查（17例BO,17例AO）,26例行MRI检查（11例BO,15例AO）;随访时间6-96个月,计算两组患者术后复发率.两组患者的年龄、肿瘤长径、病程及血碱性磷酸酶等连续变量的比较分别采用独立样本t检验（正态分布）及非参数检验（非正态资料）,累及邻骨、膨胀性骨质破坏、病变内有无钙化等分类变量的比较采用χ^2检验,P〈0.05为差异具有统计学意义.结果 BO组和AO组患者年龄分别为（19.76±10.33）、（29.82±14.69）岁,病程分别为15 （6,96）、6（1,60）个月,肿瘤长径分别为（2.08±0.64）、（4.01±1.46）cm,两组差异具有统计学意义（P〈0.05）.2例BO、9例AO具有神经受损症状,两组差异具有统计学意义（P〈0.05）.在BO组,3例病变累及邻骨,所有患者病灶内有钙化或骨化、骨皮质完整、病变周围有斑片状骨质硬化,11例病变周围有骨髓水肿及邻近软组织水肿,2例CT或MRI增强扫描明显强化;在AO组,11例病变累及邻骨,12例病变内有钙化或骨化,所有患者骨皮质不完整,11例病变周围具有斑片状骨质硬化,10例病变周围有斑片状骨髓水肿及邻近软组织水肿,10例病灶明显强化,两组上述症状及影像征象差异有统计学意义（P〈0.05）.两组患者性别、病变部位、术前碱性磷酸酶、骨质破坏类型及病变内部信号强度差异无统计学意义（P〉0.05）.BO组术后复发率为6.67%,AO组为37.50%,差异具有统计学意义（P〈0.05）.结论 患者的年龄、病程、神经受损症状等临床资料有助于鉴别BO和AO.与BO相比,AO病灶更大、骨皮质多不完整,病灶内部钙化或骨化、周围骨质硬化、骨髓水肿征象相对较少;AO组患者术后复发率高于BO组.

Objective To investigate the clinical and imaging manifestations of benign and aggressive spinal osteoblastoma. Methods Seventeen patients with benign osteoblastoma （BO） and 18 patients with aggressive osteoblastoma（AO） from May 2004 to November 2015 diagnosed by orthopedic doctor and pathologist were analyzed retrospectively. Thirty four patients （17 BO, 17 AO ） underwent CT plain scanning, 26 patients underwent MRI. The follow-up time was 6 to 96 months, the postoperative recurrence rate was calculated. The continuous variables including the age, the duration of symptoms and the size of tumor were compared between AO and BO with the 2-tailed Student t test or Mann-Whitney U test. The categorical variables were compared between AO and BO with χ2test.A P value〈0.05 was considered statistically significant. Results The age was significantly different between AO and BO [（29.82 ± 14.69） Y vs （19.76 ± 10.33）Y, P〈0.05]. The duration of symptoms was significantly different between AO and BO [15（6,96）m vs 6（1,60）m, P〈0.05].The size of tumor was significantly different between AO and BO [（4.01 ± 1.46） cm vs （2.08 ± 0.64） cm, P〈0.05]. Neurological deficit was found in 2 patients with BO and 9 patients with AO, there was significant difference（P〈0.05）.In the BO group,the adjacent bone involved（n=3）,the calcification of the lesion（n=17）,intact bony cortex（n=17）,the ill-defined sclerotic bone around the lesion（n=17）,the edema of bone marrow and adjacent soft tissue around the lesion （n=11）, and intense enhancement （n=2） were observed in BO. While in the AO group, there were 11 patients with adjacent bone involved. The calcification of the lesion （n=12）,intact bony cortex（n=0）, the ill-defined sclerotic bone around the lesion（n=11）,the edema of bone marrow and adjacent soft tissue around the lesion（n=10）, and intense enhancement （n=10） were observed in AO. The above imaging features of BO were significantly different from that of AO（P all〈0.05）.The sex distribution,the location of the lesion,preoperative ALP,the type of bone destruction,the signal intensity were not significantly different between BO and AO（P〉0.05）.The recurrence rate of AO（37.50%）was significantly different from that of BO （6.67%,P=0.04）.Conclusion The clinical features including the age,duration of symptoms,neurological deficit contributed to differentiating BO from AO.The size of AO was bigger than BO,and AO didn＇t have intact bony cortex.In the AO group,there was less calcification in the lesion,less edema of bone marrow and adjacent soft tissue around the lesion.The post-operation recurrence of AO was higher than BO.