脊柱恶性纤维组织细胞瘤临床诊治16例报告

Clinical diagnosis and treatment of the malignant-fibrous histocytoma in the spine(16cases report)

目的:探讨脊柱恶性纤维组织细胞瘤的临床特点及其手术方式.方法:1996～2001年收治16例脊柱恶性纤维组织细胞瘤患者(平均年龄47岁),经临床及影像学诊断确诊后采取手术治疗.肿瘤位于颈椎者1例,行前路肿瘤切除钢板固定;位于胸椎者6例,采用经胸入路行肿瘤切除、植骨或骨水泥椎体重建加Z-plate内固定;位于腰椎者3例,采用后路、侧方入路或胸腹联合入路行肿瘤切除、植骨或骨水泥椎体重建、后路椎弓根、Kaneda等内固定方法;位于骶椎者4例,采用TSRH腰椎骨盆内固定重建术,2例患者仅行肿瘤切除术.术前、术后均进行化疗.术后对患者疼痛情况、影像学表现等进行随访,平均随访2.5年.结果:术中平均出血量2 306ml,所有患者平均疼痛下降2.19级,7例有肿瘤复发(43.75%).未发现椎体塌陷和内固定失败.随访中全组均存活.结论:在胸腹腔等部位生长的肿瘤容易形成巨大软组织肿块,术中出血较多.根据肿瘤的不同部位,在肿瘤切除后,可以采用不同形式的椎体重建和内固定.术前术后应联合化疗.

Objective:To study the clinical features and the operative methods of the malignant-fibrous histocytoma(MFH)in the spine.Method:From Jan,1996to Dec,2001,16cases with MFH(age range,27~61years old),10male and6female,were admitted to the hospital.After the resection of the tumor lesion,one patient underwent anterior cervical procedure with anterior cervical plating;six with thoracic lesion underwent transthoracic approach,reconstructed with bone-grafting or bone cement and internal fixation with Z-plating or Kaneda;3with lumbar lesion underwent transpedicular screws fixation or Kaneda rod through posterior,lateral or abdominothoracic approaches.Four with sacral tumors underwent TSRH lumbosacral reconstruction.All patients received chemotherapy pre-and post-operatively.The patients were clinically and radiologically followed up with a mean of2.5years.Result:The mean introperative bleeding was2306millimeters.The pain scoring decreased2.19points on the average.In the total of16patients,seven developed recurrence after a mean of two years follow-up.No vertebral collapse and internal fixation failure occurred.None of them died so far as the paper was subscribed.Conclusion:The MHF tends to develop a huge mass of soft tissue in the abdominothoracic cavity.Intro-operative over-bleeding should be kept in mind by the surgeons.Based on the various approaches of the tumor lesion,the different vertebral reconstruction and internal fixation could be adopted.The pre-and postoperative chemotherapy should be indispensable part of the comprehensive treatment of the MFH.