肺癌脊柱转移瘤患者的流行病学特点研究

目的:多中心分析肺癌脊柱转移瘤患者的流行病学特点.方法:选取2006年3月～2019年9月国内6家临床医学中心住院治疗的肺癌脊柱转移瘤患者,采用查阅病历、电话随访、门诊随访的方式,统计患者性别、年龄、住院时间、吸烟史、肿瘤组织学分型、脊柱转移节段和数目、其他转移情况、神经功能Frankel分级、身体状况KPS评分,以及...     

SPECT诊断脊柱转移瘤65例分析

应用单光子发射计算机断层扫描（ＳＰＥＣＴ）确诊的６５例脊柱转移瘤结果表明，最常见的骨转移瘤部位是腰椎，３０例（４６．１％）；依次为胸椎２２例（３３．８％）；颈椎９例（１３．８％）；骶椎４例（６．１％），多椎体骨转移瘤５９例（９０．８％），单椎体骨转移瘤６例（９．２％）。脊柱转移瘤中转移灶除１例为＂冷区＂显像外，其余转移灶均为＂热区＂显像。ＳＰＥＣＴ是一种有较高灵敏度的检查方法，对脊柱转移瘤的诊断可早于Ｘ线照片，检出转移灶的数目也优于Ｘ线照片及ＣＴ，其对疗效的观察和预后判断亦有价值。     

脊柱转移瘤的预后分析

目的：探讨预测脊柱转移瘤预后的方法及按其制定治疗方案的可能性。方法：对我院1994年10月～2001年10月收治并有随访资料的41例脊柱转移瘤患者进行Cox生存分析，按照Tomita脊柱转移瘤预后评分法进行评分。保守治疗26例，手术治疗15例，其中全脊椎切除术5例。结果：30例原发癌诊断明确，11例原发癌诊断不明确。36例死亡．5例仍存活，平均生存11-3个月。生存期与Tomita脊柱转移瘤预后评分呈指数关系。保守治疗26例，疼痛，脊髓及神经根损害无明显改善；手术治疗15例，其中全脊椎切除术5例，术后疼痛均有不同程度减轻，脊髓及神经根损害均有改善。结论：原发肿瘤性质及重要脏器转移情况影响患者预后。Tomita预后评分法可有效判断预后，指导制定治疗方案。对于单发的、原发肿瘤生长较慢的脊柱转移瘤采取积极手术治疗，并结合综合治疗，可取得较满意的疗效。     

脊柱转移瘤临床、病理及手术治疗的演变：多中心回顾性研究

目的:回顾性分析接受外科干预的脊柱转移瘤患者资料,总结其临床、病理特征及手术方式的演变规律。方法:回顾性收集2007年1月至2018年12月703例脊柱转移瘤住院手术患者资料,男395例（56.19%,395/703）,女308例（43.81%,308/703）;年龄（58.14±11.46）岁（范围13~84岁）。手...     

脊柱转移瘤治疗进展

随着癌症患者生存期延长,脊柱转移瘤发病率越来越高。有学者认为脊柱转移瘤手术适应证为预期寿命3个月以上且存在神经功能缺陷,但这种观点在临床上尚未达成共识。因此,针对不同患者制定个性化治疗方案尤为重要。该文就脊柱转移瘤临床表现、病情评估、治疗等研究进展作一综述。     

脊柱转移瘤的磁共振诊断

脊柱转移瘤的磁共振诊断梁志国，李志波，于殿升，李吉脊柱是恶性肿瘤转移的常见部位，我们自１９９１年１０月～１９９３年１０月，收治经磁共振扫描检查发现并经临床证实的脊柱转移瘤２８例，现总结如下。１临床资料１．１一般资料本组２８例，男１８例，女１０例；年龄...     

脊柱转移瘤脊柱不稳研究进展

随着肿瘤患者生存期延长,脊柱转移瘤的发病率也越来越高。从解剖部位来看,硬膜外转移瘤发病率远远大于硬膜内转移瘤,前者常常导致脊柱机械稳定性的破坏,大大增加了病理性骨折的风险。此外脊柱转移瘤外科手术不断开展,在肿瘤切除、椎管减压的同时也带来了术后椎体不稳等问题。脊柱的不稳意味着在正常载荷下易出现异常活动和位移。脊柱不稳目前尚无明确的定义,作者认为这一概念应主要包括以下两方面的内容,生物力学方面:创伤、感染、肿瘤、退行性变等多种原因导致的脊柱运动节段的刚度下降、活动度增加,相同负荷下较正常椎体发生更大的位移;临床表现上,不稳脊柱在正常和(或)过度活动时出现疼痛,存在病理性骨折的风险,可能导致脊髓及神经根的压迫损伤。如果可以早期识别脊柱不稳,预测病理性骨折风险,即时采取固定术,会大大改善脊柱转移瘤患者的生活质量,延长生存期。因此,医生需要对脊柱不稳和将要发生的病理性骨折有着很好的预见性。本文主要对脊柱转移瘤椎体不稳相关研究进行综述。     

CT对脊柱转移瘤的诊断价值

[目的]探讨CT对脊柱转移瘤的诊断价值。[方法]收集2001年6月-2006年6月行脊柱CT扫描检查的病例，从中检出已证实的72例脊柱转移瘤CT扫描图像，进行回顾性分析，探讨了脊柱转移瘤溶骨型、成骨型及混合型的CT表现，并与X线片进行了比较，讨论了脊柱转移瘤的鉴别诊断以及MRI、ECT对脊柱转移瘤诊断的优缺点。[结果]72例脊柱转移瘤患者中肺癌27例，乳腺癌23例，肾癌8例，结肠癌7例，前列腺癌4例，鼻咽癌2例，甲状腺癌1例。受累椎体94个，其中累及1个椎体的35例，累及2个椎体的19例，跳跃性累及3个椎体的7例。累及颈椎18个，胸椎38个，腰椎29个，骶椎9个。72例中溶骨型转移瘤54例，成骨型转移瘤11例，混合型转移瘤7例，本组病人的X线片显示率为59．7％，CT显示率为100％。MRI对骨质破坏的显示不如CT清晰。ECT的分辨率不高，对病灶的细微结构及解剖的比邻关系显示不清，ECT的假阳性率高。[结论]脊柱转移瘤的诊断，要重视临床表现及病史，以X线片及ECT作为首选的筛选检查项目，CT作为明确诊断的检查方法，必要时行CT引导下脊椎骨穿刺活检。     

脊柱转移瘤治疗进展

脊柱是癌症患者最常见的转移部位,脊柱转移瘤导致的疼痛、脊髓压迫以及神经损害严重影响患者生活质量,放疗曾经是脊柱转移瘤的主要治疗方式。对于放疗敏感的肿瘤患者,其可有效缓解疼痛,对于放疗不敏感的肿瘤患者,立体定向放疗同样可取得良好效果。对于脊髓受压、脊柱不稳、病理性骨折患者,外科手术可解除脊髓压迫,恢复脊柱稳定性,缓解疼痛,而脊柱微创技术的应用可有效降低手术风险,同样达到治疗目的。立体定向放疗联合外科手术使外科手术变得简单,立体定向放疗可控制肿瘤进展,手术目的只是解除肿瘤脊髓压迫和稳定脊柱。而系统治疗是延长患者生存期的重要环节,新型治疗手段靶向治疗、免疫治疗的应用可显著提高疗效,改善生存状态。由于肿瘤治疗的复杂性,需要多学科协作,共同制定治疗方案。该文就脊柱转移瘤治疗进展进行综述。     

脊柱转移瘤的诊断与治疗

目的：探讨脊柱转移瘤的早期诊断及放疗加激素治疗效果。方法：回顾性分析62例脊柱转移瘤的临床特点、影像学诊断及放疗加激素的疗，结果：62例患者疼痛症状的缓解率为91．9％，50例有脊髓压迫症状的缓解率为66％，结论：脊柱转移瘤虽然预后很差，但是如能给予早期诊断及合理治疗，大多数病人的症状可以得到缓解，可延缓或防止瘫痪，提高生存质量。     

Surgery and survival outcomes of 22 patients with epidural spinal cord compression caused by thyroid tumor spinal metastases

Purpose

The aim of this study was to discuss the clinical presentation, imaging findings, treatments received, and outcome of therapies for patients with epidural spinal cord compression caused by thyroid spinal metastases, with the goal of emphasizing the importance of surgery in this setting and discussing therapeutic plan for treating these patients.

Methods

A total of 22 patients with spinal cord compression due to thyroid tumor spinal metastases who received surgery in our department were identified from 2004 to 2011. The series of 22 patients collected from our institution over the past 7 years was used to discuss treatment options for thyroid cancer spinal metastases on the basis of literature review and our own extensive experience.

Results

The mean age of the patients in this study was 57 years (range 37–78 years). The duration of the preoperative symptoms was 1–24 months, with an average of approximately 6 months. All patients attained improvement of at least one level of the Frankel classification after surgery. Two patients received more than one operation at our institution. Two patients died during follow-up, two patients had stable disease, and all other patients maintained a disease-free status during follow-up.

Conclusions

As thyroid tumor spinal metastases have a favorable prognosis, a radical therapeutic attitude should be considered in decision-making. Dorsal spinal decompression through curettage and stabilization can preserve or restore neurological function for most patients. For patients who have more than one metastatic lesion of the spine, surgeries can be sequentially performed based on the urgency of the case. In addition to treatment of primary disease, surgery and bisphosphonate treatment are the most important therapies for these patients.     

376例膝关节周围骨巨细胞瘤的临床特征分析

 目的 总结膝关节周围骨巨细胞瘤（giant cell tumor,GCT）的临床特征及影像学特点。方法 回顾性分析中国骨巨细胞瘤协作组（天津医院、济南军区总医院、西京医院、浙医二院、南京军区总医院）2000年3月至2014年7月间所有膝关节周围GCT患者的临床及影像学资料,按性别、年龄、发生部位、Campanacci分级、Ennecking分期、周围软组织受侵袭情况、病理性骨折程度和手术方式分别进行统计,分析膝关节周围GCT的临床特征。结果 共收集376例GCT患者,原发302例,复发74例;男198例,女178例;发病年龄12~78岁,平均（35.6±12.8）岁,男性发病平均年龄（37.4±13.2）岁,女性发病平均年龄（33.5±12.0）岁,女性发病年龄明显低于男性,差异有统计学意义。左膝关节175例（46.5%）、右膝关节201例（53.5%）,差异无统计学意义。股骨远端202例（53.7 %）、胫骨近端174例（46.3%）,差异无统计学意义。瘤体破坏偏心性304例（80.9%）,中心性72例（19.1 %）。未发生骨折261例（69.4%）,简单骨折73例（19.4%）,复杂骨折42例（11.2%）。结论 膝关节周围骨巨细胞瘤临床特征及影像学特点在不同年龄组、不同性别间存在差异,Campanacci影像学分级越高,其病理性骨折的发生率、囊外病变比例及采取边缘切除方式的比例就越高。     

成人腹股沟疝合并隐睾治疗效果的多中心回顾性研究(附61例报告)

目的:分析成人腹股沟疝合并隐睾的治疗方案及效果。方法:回顾分析2013年1月至2017年12月三家医院手术治疗的61例腹股沟疝合并隐睾患者的临床资料及1年随访资料。结果:61例患者中,17例(27.9%)行腹腔镜手术(腹腔镜组),44例(72.1%)行开放手术(开放组),两组患者隐睾分型、术中出血量、术后住院时间、住院费用、切口疼痛、阴囊血肿、睾丸疼痛、睾丸萎缩、血清肿发生率差异无统计学意义,腹腔镜组手术时间长于开放组(P=0.031),睾丸切除率高于开放组(P=0.022),差异有统计学意义。结论:腹腔镜手术与开放手术治疗成人腹股沟疝合并隐睾可取得较好效果,各具优势,应在术前明确诊断的前提下,选择最佳手术方案。     

Lumbar extradural infiltrating angiolipoma: a case report and review of 17 previously reported cases with infiltrating spinal angiolipomas

BACKGROUND CONTEXT: Spinal extradural angiolipomas are rare benign tumors, and most of them are noninfiltrating tumors located in the extradural space. However, there are 17 cases with extradural infiltrating spinal angiolipomas extending into the vertebral bodies or posterior vertebral arches in literature. These 17 tumors are mostly located at the thoracic region, and anterior or in the anterolateral extradural space, and they generally infiltrate only one vertebra. Only two of them are located at the lumbar region, four are mainly located in the posterior extradural space, and three infiltrate more than one vertebra. PURPOSE: To present an exceptional case with infiltrating extradural spinal angiolipoma involving two lumbar segments and mainly located in the posterior extradural space. STUDY DESIGN: A case report. METHODS: A 41-year-old woman with infiltrating spinal angiolipoma was treated by incomplete surgical removal of the tumor. RESULTS: There were no complaints nor recurrence after 18 months follow-up. CONCLUSIONS: Outcome after surgery for spinal angiolipomas is very good overall even in the cases with infiltrating tumors. Although complete removal is certainly preferred, outcomes remained favorable despite incomplete resections.     

Thoracic spine intra- and extradural dumbbell-shaped meningioma: Case report and extensive review of the literature with 21 cases

Introduction

Spinal dumbbell-shaped meningioma is a rare condition usually mistaken preoperatively for schwannoma. The present study reported a case of dumbbell-shaped meningioma, with an extensive review of literature.

创伤骨科住院患者手术部位感染的流行病学特点及相关危险因素分析：单中心回顾性研究

目的调查本院创伤骨科手术部位感染（surgical site infection,SSI）患者的发病情况,并分析感染原因,为预防和控制SSI提供依据。 方法选取本院自2015年1月至2019年12月期间创伤骨科所有住院手术患者为研究对象,共计10 645例患者,依据卫生部2001年颁布的《医院感染诊断标准（试行）》进行医院感染病例诊断,并根据临床科室上报的医院感染资料信息进行病历筛选和回顾性分析。 结果10 645例创伤骨科手术患者中,31例患者发生SSI,感染发生率为0.29%。2016年至2019年感染发生率呈逐年下降趋势。感染的主要病原菌为G（+）球菌,占87.50%。感染类型主要是器官（或腔隙）感染,占61.29%。患者年龄、体重指数、手术时间、手术方式、手术部位与骨科手术患者SSI的发生有相关性（P<0.05）。 结论创伤骨科手术患者SSI是临床上不可回避的问题,应重视相关危险因素,积极采取有针对性的预防控制措施改善可变因素,以有效降低骨科手术患者SSI的发生。     

Clinical characteristics and treatment options for two types of osteoblastoma in the mobile spine: a retrospective study of 32 cases and outcomes

Purpose

A retrospective study of 32 patients with osteoblastoma (OBL) in the mobile spine was performed to analyze the clinical characteristics of two types of spinal OBL. We also aimed to find influential factors for OBL in the mobile spine.

Methods

Between 2002 and 2011, 32 patients with either conventional osteoblastoma (CO) or aggressive osteoblastoma (AO) in the mobile spine were treated in our center. All patients were treated with either total excision or subtotal excision + postoperative radiotherapy. The mean follow-up was 45.8 (18–128) months. Clinical data and surgery efficacy were analyzed to search for clinical characteristics of two subtypes of spinal OBL and discuss the possible factors influencing relapse.

Results

There is significant difference between CO and AO in tumor size (p < 0.0005), preoperative alkaline phosphatase (ALP, p < 0.0005) and intraoperative blood loss (p = 0.013). Multivariate logistic regression was used to find the influential factors for relapse and the results were: preoperative ALP, b = 0.023, p = 0.029; surgery protocol, b = −7.597, p = 0.007; tumor size, ≥3/<3, b = 24.805, p < 0.0005; age, b = 0.054, p = 0.632; and pathology type, b = 1.998, p = 0.34.

Conclusions

Tumor size, preoperative ALP and CT images were helpful for distinguishing AO from CO. The difference in intraoperative blood loss between CO and AO is mainly attributed to the size of the lesion. Preoperative ALP, surgery protocol and tumor size (≥3/<3) were considered to significantly influence relapse of spinal OBL.

Electronic supplementary material

The online version of this article (doi:10.1007/s00586-013-3049-1) contains supplementary material, which is available to authorized users.     

单中心原发骶骨肿瘤790例的流行病学分析

目的 :总结原发骶骨肿瘤的流行病学特点、手术方式及治疗效果。方法 :2000年7月~2013年12月在北京大学人民医院骨与软组织肿瘤中心接受手术治疗的骶骨原发肿瘤患者790例,其中男416例,女374例。发病年龄5~78岁,平均44.8岁。病理类型:脊索瘤193例,骨巨细胞瘤141例,神经纤维瘤83例,神经鞘瘤48例,恶性外周神经鞘瘤19例,骨髓瘤39例,骨肉瘤26例,软骨肉瘤49例,尤文肉瘤/PNET 28例,畸胎瘤37例,其他肿瘤127例。随访期3~5年。分析上述主要病理类型病例的男女比例、年龄特点、病灶部位及生长特点、手术方式、局部复发及生存率。结果:1脊索瘤193例,占24.4%。男120例,女73例,平均年龄56.7岁(21~75岁)。89例累及S3以下的患者接受了广泛或边缘性切除;70例累及S2以下的患者接受了整块切除,其中21例整块切除后肿瘤上缘骶骨有残留,进行了补充切除;34例肿瘤累及全骶骨的患者中,19例接受了全骶骨整块切除手术,余患者行分块切除术。远处转移19例(9.8%),包括肺转移10例,骨转移6例,肝转移3例。151例首次手术的患者中57例局部复发(37.7%)。术后5年无病生存率45.1%,5年总生存率87.7%。2骨巨细胞瘤141例,占17.8%。其中男69例,女72例,平均年龄34.2岁(16~61岁)。132例行切刮术,3例行全骶骨切除术,6例因肿瘤巨大仅行多次血管栓塞术。术后共25例复发(18.9%),13例为采用术中腹主动脉球囊临时阻断者,12例为未采用腹主动脉球囊临时阻断者。3神经源性肿瘤150例,占骶骨原发肿瘤的19%。分别为良性神经源性肿瘤131例(神经纤维瘤83例、神经鞘瘤48例)和恶性神经鞘瘤19例。131例良性神经源性肿瘤中,男62例,女69例,平均年龄为42.3岁(17~67岁);均行边缘性切除,17例(12.9%)术后复发。4骨肉瘤26例,占3.3%。男15例,女11例,平均年龄25.8岁(12~58岁)。16例行术前化疗,21例行术后化疗。13例行整块切除术或全骶骨切除术,13例行分块切除术。12例(46%)手术后复发。术后3年及5年生存率分别为43.5%和21.8%。5尤文肉瘤/PNET 28例,占3.5%。男13例,女15例,平均年龄22.3岁(5~50岁)。21例行术前化疗,27例行术后放化疗。14例行整块切除术或全骶骨切除术,14例行分块切除术。15例(53.6%)手术后复发。术后3年及5年生存率分别为39.1%和19.6%。6软骨肉瘤49例,占6.2%。男26例,女23例,平均年龄42.5岁(17~69岁)。29例行整块切除术或全骶骨切除术,余行分块切除术。22例(44.9%)手术后复发。术后2年及5年总生存率分别为58.7%和47.0%;术后2年及5年无病生存率分别为42.3%和31.8%。结论:最常见的原发骶骨肿瘤为脊索瘤、骨巨细胞瘤、神经源性肿瘤、骨肉瘤、尤文肉瘤、软骨肉瘤和骨髓瘤。各肿瘤的好发年龄、性别比例、部位及生长方式各有特点。不同的病理类型应选择不同的手术方式。骶骨脊索瘤肿瘤整块切除的术后复发率远低于病灶内手术;骶骨巨细胞瘤治疗最大的难点和关键点是控制术中出血;骶骨原发高度恶性肿瘤如骨肉瘤、尤文肉瘤等边缘或病灶内手术后复发率极高,应行肿瘤整块广泛切除。     

Primary liposarcoma of the thoracic spine: case report

Liposarcoma is a malignant tumor of soft tissue. The thoracic spine is an unusual location, even for metastasis, and to our knowledge, no case of primary pleomorphic liposarcoma of the vertebral body has been reported until now. A female patient presented with paraplegia. She had a previous medical history of mental depression, and complained of dorsal pain for three months following a road accident. Magnetic Resonance Imaging (MRI) revealed a collapse of T7-T8, and the diagnosis of plasmocytoma was made. She was treated with decompressive laminectomy and posterior instrumentation. Histological examination revealed a pleomorphic liposarcoma. She received a course of radiotherapy. At 13 months follow-up she developed pulmonary metastases and rib involvement. The spine is an unusual location for pleomorphic liposarcoma, even as metastasis. The differential diagnoses of this rare entity are discussed, as well as the criteria for diagnosing primary spinal liposarcoma. Although rare, our case demonstrates that liposarcoma should be considered in the differential diagnosis of spinal tumors.