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目的探讨脊柱骨母细胞瘤的临床特点、治疗方法及预后。方法回顾性分析2001年7月至2009年7月本院收治的12例脊柱骨母细胞瘤患者的临床表现、诊断和治疗方法。结果其中男4例,女8例;中位年龄21岁(9～63岁)。累及颈椎1例,胸椎4例,腰椎3例,胸腰段1例,骶椎3例。均有疼痛,伴有神经损伤症状6例,伴有脊柱侧凸4例,1例患者存在肿块,1例存在脊髓压迫。7例为复发病例或术前活检明确诊断,4例患者术前影像学表现典型,考虑为骨母细胞瘤,其中1例误诊为骨肉瘤。所有患者均行手术治疗,根据肿瘤部位不同采取前路、后路或前后路联合肿瘤切除,并予以相应方式重建。手术时间平均3.3h(1.5-6.5h)。出血量平均1975ml(300～4500ml)。术后疼痛和神经根损害表现均消失,3例脊柱侧弯患者畸形得到纠正,2例患者4次出现脑脊液漏,经应用抗生素和床尾抬高治疗后愈合。10例随访平均4年(1-8年),2例分别于术后3个月、2年6个月复发,其余均无疼痛症状,未见肿瘤复发。结论脊柱骨母细胞瘤临床特征复杂,临床表现、影像学检查结合穿刺病理有助于确诊。根据不同的肿瘤部位,采取不同的手术入路行彻底的切除肿瘤能够取得良好效果。
Objective To investigate the clinical features, treatment and prognosis of spinal osteoblastoma. Methods The clinical manifestations, diagnosis and treatment of 12 patients with spinal osteoblastoma admitted to our hospital from July 2001 to July 2009 were analyzed retrospectively. Results of which 4 males and 8 females; median age of 21 years (9 to 63 years old). 1 case involved the cervical spine, 4 cases of thoracic spine, 3 cases of lumbar spine, 1 case of thoracolumbar and 3 cases of sacral spine. All had pain, accompanied by nerve injury symptoms in 6 cases, accompanied by scoliosis in 4 cases, 1 case of patients with mass, 1 case of spinal cord compression. Seven cases were diagnosed as recurrence or preoperative biopsy. Four cases had typical preoperative imaging findings, which were considered as osteoblastoma. One case was misdiagnosed as osteosarcoma. All patients underwent surgical treatment, according to the different parts of the tumor to take anterior, posterior or anterior and posterior combined tumor resection, and be reconstructed accordingly. The average operation time 3.3h (1.5-6.5h). The average amount of bleeding 1975ml (300 ~ 4500ml). Postoperative pain and radicular injury disappeared. Three patients with scoliosis were corrected for malformations. Cerebrospinal fluid leakage was observed in four of the two patients and healed by antibiotics and bed-tail elevation. Ten patients were followed up for an average of 4 years (1-8 years). Two patients relapsed after 3 months and 2 years and 6 months respectively. The rest had no pain symptoms and no tumor recurrence. Conclusions The clinical features of spinal osteoblastoma are complex. The clinical manifestations, imaging findings and puncture pathology are helpful for the diagnosis. According to different tumor sites, taking a different surgical approach thorough removal of the tumor can achieve good results.