14例脊柱骨样骨瘤的临床特征及外科治疗

Retrospective analysis of clinical features and surgical treatment of 14 patients with spinal osteoid osteoma

目的探讨脊柱骨样骨瘤的临床特征和外科切除的临床疗效。方法回顾性分析武汉大学中南医院2008年6月至2018年6月诊治的14例脊柱骨样骨瘤患者。其中男8例,女6例;平均年龄(37.4±11.2)岁(11~63岁);病程(7.5±2.1)个月(4~13个月)。病灶位于颈椎2例、胸椎4例、腰椎5例、骶椎3例,所有患者术前均行X线、CT及MRI检查,术后病理结果均证实为骨样骨瘤。临床疗效评价采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数问卷表(ODI)及美国脊髓损伤协会(ASIA)制定的神经功能评分来评估脊髓功能,随访期间观察并发症、术前症状和脊髓功能恢复情况。结果本组所有患者均获随访,平均(31±2)个月(19~42个月),VAS评分由术前(6.4±1.8)分减小到(0.7±0.7)分,VAS变化存在统计学意义(P<0.001),ODI评分由术前(53.8±8.1)分减小到(21.2±5.9)分(P<0.001),差异具有统计学意义;术前神经功能ASIA分级:C级2例,D级7例,E级5例。术后3个月随访D级2例,E级12例,末次随访中术前有脊髓神经功能障碍者均恢复至ASIA E级。术后1例患者出现手术切口脂肪液化,1例出现神经功能损害加重的症状,经对症治疗后逐渐缓解,余末次随访均未见肿瘤复发或恶变等并发症。结论位于椎体及附件的脊柱骨样骨瘤临床表现复杂多样,薄层CT能够快速准确诊断及定位瘤巢,而对于毗邻神经及血管的肿瘤,积极的手术切除仍是脊柱骨样骨瘤的有效治疗方式。

Objective To investigate the clinical features of spinal osteoid osteoma and the clinical effect of surgical intervention. Methods From June 2008 to June 2018, 14 patients(8 males and 6 females) with spinal osteoid osteoma treated in Zhongnan Hospital of Wuhan University were included. The mean age was(37.4±11.2) years(range 11-63 years). The mean course was(7.5±2.1) months(range 4-13 months). The lesions were located in cervical vertebrae in 2 cases, thoracic vertebrae in 4 cases, lumbar vertebrae in 5 cases and sacral vertebrae in 3 cases. X-ray, CT and MRI were performed in all patients before operation, and osteoid osteoma was confirmed by postoperative pathology.The clinical efficacy was evaluated by the visual analogue scale(VAS), Oswestry disability index questionnaire(ODI)and the American spinal injury association(ASIA) impairment scale to evaluate neurological function. Complications,preoperative symptoms and recovery of neurological function were observed during follow-up. Results All patients underwent a complete follow-up with an average of(31±2) months(range 19-42 months). Postoperatively, VAS scores decreased from(6.4±1.8) to(0.7±0.7)(P<0.001). The preoperative and final ODI scores were(53.8±8.1) and(21.2±5.9), respectively, reflecting a significant decrease(P<0.001). Postoperative ASIA classification: 2 cases of grade C, 7 cases of grade D, 5 cases of grade E. ASIA classification(3 months postoperatively): 2 cases of grade D,12 cases of grade E. And all cases had ASIA score improved to grade E after operation at the last follow-up. Postoperative fat liquefaction occurred in 1 case, neurological impairment aggravated in 1 case, and were relieved by symptomatic treatment. Other cases were all relieved from pain and no evidence of local recurrence existed. Conclusion The clinical presentations of spinal osteoid osteoma located in the vertebral body and appendages are complex and diverse. The nidus can be diagnosed and located precisely by thin-section CT scan, but for nidus adjacent to nerves and blood vessels, surgical resection remains an effective treatment for spinal osteoid osteoma.