脊柱动脉瘤样骨囊肿的诊治:一项单中心病例回顾性研究

Diagnosis and treatment of primary spinal aneurysmal bone cyst: a single-center case retrospective study

目的:分析脊柱动脉瘤样骨囊肿不同治疗方案的疗效。方法:回顾性分析2010年11月至2020年11月收治的脊柱动脉瘤样骨囊肿患者,收集患者基本信息、术前脊髓功能评分、病灶定位、治疗方式、术后缓解情况等指标。结果:本研究共纳入10例脊柱动脉瘤样骨囊肿患者。其中男7例,女3例,年龄11~41岁。以单纯脊柱区域疼痛症状发病者2例,以脊柱区域疼痛合并肢体神经症状发病者8例,其中3例Frankle分级D级,1例Frankle分级C级,其余4例Frankle分级E级。1例发病于颈椎,3例发病于胸椎,6例发病于腰椎。2例仅脊髓后方结构受累,8例脊髓前方及后方结构均受累。7例接受开放手术治疗,其中6例术后症状明显缓解,5例长期随访无复发;2例接受动脉栓塞术微创治疗,症状均明显缓解,长期随访病变缩小、骨化明显;1例接受地舒单抗药物治疗,症状明显缓解,末次随访病灶缩小、骨化明显。结论:脊柱动脉瘤样骨囊肿病灶范围及疾病严重程度各不相同。根据病情为每例患者提供个体化的手术方案,有助于缓解疼痛、解除神经压迫、维持脊柱稳定性、重建骨性结构,并减少术后复发,增加患者获益。

Objective: To investigate the efficacy of different treatment strategies for spinal aneurysmal bone cyst. Methods: Patients with spinal aneurysmal bone cyst treated between November 2010 and November 2020 in our hospital were retrospectively analyzed.The basic information, preoperative spinal cord function score, lesion location, treatment strategies, and postoperative remission were collected. Results: Ten patients were included in this study, including 7 males and 3 females aged from 11 to 41 years old. Two patients presented with local pain in the spine. Eight patients presented with local pain in the spine and neurologic symptoms of extremities,among whom 3 were Frankle Stage D, 1 was Frankle Stage C, and 4 were Frankle Stage E. The cyst arose in the cervical spine in one patient, in the thoracic spine in 3 patients and in the lumbar spine in 6 patients. Only posterior spine was involved in 2 patients, and both anterior and posterior spine were involved in 8 patients. Seven patients received open surgery, among whom 6 patients had symptom relief and 5 patients had no recurrence in long-term follow-up. Two patients received minimally invasive arterial embolization, and clinical symptoms were significantly relieved, the lesions were reduced and ossified in long-term follow-up. One patient was treated with denosumab, and the symptoms were relieved, the lesions were reduced and ossified in the last follow-up. Conclusions: The tumor size and severity of spinal aneurysmal bone cyst are varied in patients. Personalized operation scheme is helpful to relieve pain and nerve compression, maintain spinal stability, reconstruct bone structure, reduce postoperative recurrence and increase the benefit of patients.