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目的研究扩大刮除术治疗脊柱骨巨细胞瘤的疗效。方法回顾性分析2006年5月至2012年5月,北京积水潭医院骨肿瘤科收治的具有完整临床病理及随访资料的18例初次诊治的脊柱骨巨细胞瘤病例。其中男8例,女10例,平均年龄31.6岁;患者术前均有不同程度疼痛症状,5例合并脊髓功能受累;病变累及颈椎1例,胸椎9例,腰椎8例。手术方式均采取扩大刮除术,10例行单纯前路手术,3例行单纯后路手术,5例行前后联合入路手术。术后行辅助放疗患者10例,未行放疗患者8例,其中单纯前路手术患者6例,单纯后路手术患者1例,前后联合入路手术患者1例。随访观察治疗效果。结果 18例获中位46(12~83)个月随访。4例复发(22.2%),平均复发时间34.5(6~71)个月,均为单纯前路手术且术后未行辅助放疗患者。其中3例再次行手术扩大刮除及辅助放疗,1例行单纯放疗。此4例再治疗后平均随访36(12~59)个月,未见复发。术后疼痛消失11例,疼痛缓解7例;5例脊髓功能受累病例均获不同程度改善;1例术后27个月出现椎弓根钉折断。结论单纯扩大刮除术简单、易行,辅以术后放疗可以有效治疗脊柱骨巨细胞瘤,局部复发率并不高于其它治疗方法。
Objective To study the effect of expanding curettage on giant cell tumor of the spine. Methods From May 2006 to May 2012, 18 cases of first diagnosed and treated giant cell tumor of the spine with complete clinical pathology and follow-up data from Beijing Jishuitan Hospital were enrolled. There were 8 males and 10 females, with an average age of 31.6 years. All patients had pain symptoms before operation and 5 cases had spinal cord involvement. The lesions included 1 cervical, 9 thoracic and 8 lumbar vertebrae. Surgical methods were taken to expand the curettage, 10 cases of simple anterior surgery, 3 cases of simple posterior surgery, 5 cases before and after the combined approach. There were 10 cases of adjuvant radiotherapy and 8 cases of radiotherapy. Among them, 6 cases were treated with anterior surgery alone, 1 case was treated with posterior approach alone and 1 case was operated with anterior or posterior approach. Follow-up observation of the therapeutic effect. Results 18 cases were the median 46 (12 ~ 83) months follow-up. 4 cases had recurrence (22.2%), and the average recurrence time was 34.5 (range, 6 ~ 71) months, all of which were treated by anterior surgery alone without radiotherapy. Three of them underwent surgery to expand curettage and adjuvant radiotherapy again, and one patient underwent radiotherapy alone. The four cases were followed up for an average of 36 (12 ~ 59) months after re-treatment, and no recurrence was found. Postoperative pain disappeared in 11 cases, pain relief in 7 cases; 5 cases of spinal cord involvement were improved to varying degrees; 1 case 27 months after the occurrence of pedicle screw fracture. Conclusions The simple expansion of curettage is simple and easy to perform, and combined with postoperative radiotherapy can effectively treat giant cell tumor of the spine. The local recurrence rate is not higher than other treatment methods.