寰枢椎浆细胞瘤的外科治疗及预后

Surgical treatment and survival analysis of plasmacytoma in the atlantoaxial spine

目的评估寰枢椎浆细胞瘤的外科治疗疗效及预后影响因素。方法回顾性分析北医三院1999~2015年期间骨科住院治疗且病理诊断明确的12例寰枢椎浆细胞病的临床和影像学资料。评估患者脊柱的稳定性、疼痛程度、神经功能状态和生活质量,分析患者的外科治疗疗效及分析可能影响患者生存期的相关因素(年龄、化疗、放疗、手术、血红蛋白、白蛋白、血钙)。结果 9例脊柱肿瘤稳定性评分(spinal instability of neoplasm score,SINS)中位数为13分,显示明显不稳定。8例获得随访,末次随访4例仍存活。患者的疼痛程度和生活质量明显好转。中位视觉疼痛评分(visual analog scale,VAS)由7分降低至1分(Z=2.371,P<0.05),中位Karnorfsky评分由55分升高至80分(Z=2.375,P<0.05)。有神经功能障碍的3例中,2例有明显恢复。单因素分析的结果表明化疗、血红蛋白和年龄是影响寰枢椎浆细胞瘤患者生存期的关键因素。结论寰枢椎浆细胞瘤患者疼痛程度重,生活质量低,多数就诊时寰枢椎关节稳定性较差,部分有神经功能障碍。恰当的外科治疗可以有效缓解患者的疼痛程度、提高生活质量、改善神经功能。化疗、血色素和年龄是影响寰枢椎浆细胞瘤患者生存期的相关因素。

Objective To evaluate the efficacy of surgical treatment and the prognostic factors of plasmacytoma in the atlantoaxial spine. Methods From 1999 to 2015, 12 patients diagnosed as plasmacytoma in the atlantoaxial spine were reviewed retrospectively. By assessing patients＇ spinal instability and comparing patients＇ pain scale, neurological function and quality of life preoperatively and postoperatively, we evaluated the clinical features and the prognosis of surgical treatment. We also analyzed the relevance between survival time and potential significant factors（ age, chemotherapy, radiotherapy, surgery, hemoglobin, albumin, blood calcium）. Results The mean spinal instability of neoplasm score（ SINS） was 13 in 9 patients, indicating instable spine. Eight patients were followed up. Four patients were still alive at the last follow-up. The severity of the pain and quality of life were improved significantly. The median VAS reduced from 7 to 1（ Z = 2.371, P〈0.05）. The median Karnorfsky performance score increased from 55 to 80（ Z = 2.375, P〈0.05）. For 3 patients who had neurological deterioration, 2 of them improved significantly. The univariate analysis indicated that chemotherapy, age and hemoglobin（ 〈110 g/L） were significantly associated with the survival time. Conclusions The patients of plasmacytoma in the atlantoaxial spine are characterized by severe pain of the neck and low quality of life. Many patients have poor spinal instability, while some of them have neurological deterioration. Appropriate surgical treatment can effectively relieve the pain, improve the quality of life. The survival time is mainly influenced by chemotherapy, age and hemoglobin.