论文部分内容阅读
[目的]探讨脊椎血管瘤的外科治疗策略.[方法]回顾1997年10月～2008年10月间的33例脊椎血管瘤.女19例,男14例;平均年龄54岁.13例患者因局部疼痛就诊;12例截瘫;8例存在神经根刺激症状和局部疼痛.9例患者为单纯局部疼痛,影像学无脊髓及神经根压迫,行经皮椎体成形术.24例患者存在硬膜囊或神经根压迫、软组织包块较大、或脊柱不稳,接受开放手术.其中,9例肿瘤主要侵犯椎体、伴有不同程度椎体压缩骨折或存在椎旁软组织包块,行前路手术治疗;12例肿瘤主要累及附件及椎体后缘.肿瘤突入椎管内压迫脊髓及神经根而无明显椎体压缩骨折,行后路手术,其中4例椎体内病灶较大,术中直视下行椎体成形术;3例肿瘤广泛累及椎体及附件,肿瘤侵入椎管内,椎体侧方存在软组织包块,行前后路联合手术.3例术前行节段动脉栓塞术.[结果]9例行单纯椎体成形的患者无围手术期并发症,平均随访41个月,疼痛均完全或明显缓解.开放手术的24例,无围手术期死亡患者.前路手术平均出血为2 739 ml,后路手术平均出血为1 619 ml(P=0.12).1例腰椎前路手术患者术后出现椎体周围血肿并继发下肢静脉血栓.1例胸椎后路手术患者术后出现血肿后截瘫加重.1例腰椎后路手术患者出现伤口感染.19例患者开放手术前存在疼痛,手术后17例疼痛完全或明显缓解.12例截瘫患者的Frankel脊髓功能评分提高1～2级.行开放手术患者平均随访48个月.X线片示内固定物无移位、折断.1例死于其他肿瘤.影像学证实肿瘤复发或发展者4例,2例尤症状给予观察,1例因疼痛行放疗,1例因截瘫再次手术.[结论]根据脊椎血管瘤患者症状产生的病因以及患者一般情况,应用多种相应外科技术治疗脊椎血管瘤,可以取得较好的临床效果.“,”[Objective]To discuss the surgical treatment strategy of spinal hemangioma.[Methods]Data on 33 patients with spinal hemangioma treated from October 1997 to October 2008 were reviewed. There were 19 females and 14 males. The average age was 54 years old. Chief complaints were pain (n = 13), myelopathy (n = 12), radiculopathy plus local pain ( n = 8) . Nine patients without spinal cord and radial nerve compression underwent percutaneous vertebroplasty ( PVP), and 24 patients with spinal cord and radial nerve compression, paravertebral soft tissue mass or spinal unstability were treated by operation. Anterior, anteroposterior and posterior approaches were used in 9, 12, and 3 patients respectively. Transarterial embolization was done in 3 patients.[Results]No perioperative complication was observed in 9 patients after PVP, with a mean follow -up of 41 months. Pain was relieved. There was no perioperative death among the 24 patients who received operation. The blood loss during operation was 2739 ml and 1619 ml for anterior and posterior approaches, respectively ( P = 0. 12) . One case of paravertebral hematoma, one case of spinal canal hematoma, and one case of wound infection were observed in this group. Pain was relieved in 89% (17/19) of the patients. According to the Frankel Scale, the neurologic situation was improved in all the 12 patients with myelopathy. By a mean follow - up of 48 months, no internal fixation failure was seen. Tumor recurrence or growth was found in 4 patients, two had no symptoms and one underwent radiotherapy for pain. Repeated operation was performed in one patient with myelopathy.[Conclusion]Most patients with symptomatic spinal hemangioma could be treated successfully by surgery. Individual surgical plan should be made according to the reason causing symptoms and the general condition of the patient.