脊柱原发软骨肉瘤的外科治疗

目的：探讨脊柱原发软骨肉瘤的治疗方法及预后。方法：对1993年-2005年收治的16例脊柱原发软骨肉瘤进行回顾性分析。男9例，女7例；年龄19—69岁，平均44岁。累及胸椎7例，腰椎2例，胸腰椎多发1例，骶椎6例。8例伴神经损伤症状，Frankel分级C级3例，D级5例。1例骶骨巨大软骨肉瘤因去分化改变采取化疗，因化疗无效患者放弃治疗出院；其余15例均行手术治疗，根据肿瘤部位不同采取前路、后路或前后路联合肿瘤切除术，并予以相应重建方式。结果：15例手术患者术后随访1—13年，平均6．2年。1例死于术后肺栓塞。术前有神经症状者中1例Frankel C级患者术后无改变，其余7例（87．5％）术后Frankel分级均改善1个等级。2例出现去分化改变，于术后12个月内死亡。术后复发7例，占47％（7／15），复发1次者4例（4／15，27％），复发2次以上者3例（3／15，20％）。除1例去分化软骨肉瘤外，其余6例每次复发后均行手术再次切除。至今存活12例，生存时间1-19年，平均7．5年。结论：对于脊柱原发软骨肉瘤，首选广泛性切除，对难以达到广泛切除者．应尽量争取彻底切除；对复发肿瘤，仍应争取再次手术并尽可能彻底切除，可达到一定的生存时间及功能保留。

Surgical treatment of primary spinal chondrosarcoma

Objective:To study the clinical features,treatment strategy and prognosis of primary spinal chondrosarcoma(SCH).Method:16 patients were retrospectively investigated from 1993 to 2005,of these,there 9 males and 7 females with age ranged from 19 to 69 years(average,44 years).The tumor involved thoracic vertebrae in 7 cases,lumbar vertebrae in 2 cases,mixed thoracic-lumbar segments in 1 case and sacral vertebrae in 6 cases.Of 8 cases with neurological deficit,3 cases were in grade C and 5 cases in grade D based on Frankel system.Only 1 patient was subjected to chemotherapy for dedifferentiated chondrosarcoma and the others underwent tumor resection including anterior approach,posterior approach or combined spondylectomy followed by stablility reconstruction.Result:The follow-up period ranged from 1 to 13 years(average,6.2 years).1 patient died of pulmonary embolism the day after operation.7 patients(7/8,87.5%) with neural deficits obtained satisfied outcomes.The tumor of 3 cases progressed into dedifferentiation,in which two died in 12 months and the other one lost follow-up.7 patients(47%) had isolated tumor recurrence.The rate of recurrence for only one time was 27% and 20% for more than two times.12 paitents were alive,the mean survival time was 7.5 years.Conclusion:For patients with primary SCH,en bloc resection was preferred in priority,for the tumor not being excised en bloc and/or recurrent tumor,tumor resection as extensive as possible should be performed for better prognosis of and functional retaining.