脊柱恶性纤维组织细胞瘤的手术治疗

【目的】总结7例脊柱恶性纤维组织细胞瘤（MFH）的临床表现、病理特点、治疗及预后。【方法】回顾分析7例脊柱MFH患者的临床和病理资料,其中3例仅行单纯后路肿块切除,1例行骨水泥填充加活检术,2例行后路肿块切除＋椎弓根系统重建,1例行前路病灶切除＋内固定自取髂骨植骨术。对其术后神经功能、疼痛程度、影像学表现及术后复发情况进行随访。【结果】7例患者术后免疫组化均有CD68表达。术中平均出血量为1300mL,全组无手术死亡,VAS术后一个月平均改善4．3分,2例神经功能明显改善。术后随访3个月至5年,2例1年后局部复发。3例生存期大于1年,1年生存率为60％。【结论】脊柱MFH恶性程度较高,早期转移及局部复发率高,手术根治性切除加术后辅助放化疗可获得较好的效果。

Malignant Fibrous Histocytoma in the Spine Treated by Surgery

[Objective]To summarize the clinical and pathological features, treatment and prognosis of 7 patients with malignant fibrous histocytoma（MFH）. [Methods] From 2002 to 2008, 7 cases with MFH（6 male and 1 female） were admitted to the hospital. Three cases underwent the resection of the tumor by the posterior approach only. One case underwent percutaneous vertebroplasty（PVP）. Two cases underwent the posterior debridement and internal fixation. One case was treated by anterior focus debridement with autogenous bone grafts and internal fixation. Neurological function, pain and the imaging manifestation and recurrence after operation were followed up after surgery. [Results]The expression of CD68 in the 7 patients were positive. The mean intraoperative bleeding was 1300ml. The mean VAS scores improved 4.3 points at 1 month after operation. During the follow-up of 3 months to 5 years, there was no death during the surgery and the neurological function of 2 cases improved after operation. Six cases of 7 survived more than 1 year. The 1 year survival rate was 60%. Two cases developed recurrence after the mean of 2 years follow-up. [Conclusion]MFH is an aggressive tumor and has high rate of the early metastasis and recurrence. The radical excision combined with adjuvant radiochemotherapy has good effect for MFH.