脊柱骨样骨瘤的诊断和手术治疗

Diagnosis and surgical treatment of spinal osteoid osteoma

目的探讨脊柱骨样骨瘤的流行病学特征、临床影像学表现和手术治疗效果。方法1991年12月至2016年8月北京积水潭医院骨肿瘤科共收治脊柱骨样骨瘤患者27例。男18例,女9例;平均年龄21.7(11～44)岁;位于颈椎5例,胸椎7例,腰椎11例,骶骨4例;位于椎体4例,脊柱附件23例。结果入院前患者平均疼痛时间10(4～24)个月。8例腰椎骨样骨瘤患者伴有神经症状,出现下肢放射性疼痛。X线片及CT检查,27例患者均可见局部高密度影。诊断明确后均接受非甾体抗炎药治疗1～2个月,服用药物期间疼痛缓解,停药后疼痛重新出现。4例位于椎体的病变采取前方入路手术,23例位于脊柱附件的病变采取后正中入路手术,术后大体标本呈淡红色,瘤巢为沙砾样颗粒,周围为反应性硬化骨,病理确诊为骨样骨瘤。术后第2天疼痛明显减轻,无需再口服止痛药,疼痛性质改变,由术前发生于深部的疼痛变为伤口的浅表疼痛。术后平均随访时间33(12～74)个月,末次随访时行影像学检查未见肿瘤局部复发,所有患者疼痛完全消失。结论脊柱骨样骨瘤诊断依靠典型的临床症状和影像学表现,手术切除是脊柱骨样骨瘤公认有效的治疗方法,术中定位瘤巢非常重要,完整去除瘤巢是避免复发的关键。

Objective To investigate the diagnostic method and surgical treatment of spinal osteoid osteoma . MethodsTwenty-seven patients with spinal osteoid osteoma were treated in Department of Orthopaedic Oncology, Beijing Jishuitan Hospital between December 1991 and Augest 2016. There were 18 males and 9 females. The mean age was 21.7(range 11- 44)years. Five cases were in cervical spine and 7 cases in thoracic spine and 11 cases in lumbar spine and 4 cases in sacrum. Four cases were in vertebra and 23 cases in posterior element. ResultsThe mean pain duration was 10(range 4-24)months. There was typical night pain. Eight patients presented with radiating pain. All patients presented with local high density shadow in X-ray. The low density nidus could be seen in CT scan with sclerosis peripherally. Seven patients received MRI and 5 patients received bone scan. The NSAIDs were used 1-2 months after diagnosis. The pain was gone when NSAIDs used and came back when NSAIDs stopped. Four patients with vertebral body tumor were treated by surgery through anterior approach and 23 patients with posterior element tumors were treated through posterior approach. The specimens were pink and the diagnosed were osteoid osteomas . The pain was improved the day after surgery. The oral analgesia was not needed. The pain was changed from deep pain to superficial pain after surgery. All the patients were followed-up in mean 33(12-74)months. No local recurrence was found and the pain disappeared. ConclusionThe diagnosis of spinal osteoid osteoma relies on typical clinical and imaging manifestation. Surgical removal is the treatment well accepted . The nidus localization is very important . Totally removal of nidus is the key to avoid recurrence.