5例骨软骨发育异常导致脊柱侧凸的手术治疗

[目的]探讨骨软骨发育异常导致脊柱畸形的特征,探讨其临床特点及手术方法的选择.[方法]2001年1月～2008年6月共收治5例骨软骨发育异常患者,均以脊柱侧凸或后凸就诊入院,男2例,女3例;术前常规进行X线片、CT和MRI检查,就其临床特点及外科治疗进行回顾性分析.[结果]对本组脊柱侧凸患者均行手术治疗,顺利完成手术,未出现脊髓血管损伤等严重并发症,颈椎不稳、胸腰段后凸、侧凸和椎管狭窄在本组骨软骨发育不良患者中常见.5例患者均获得随访,随访12～24个月,平均随访15.6个月,采用Frankel脊髓评分,术前患者评分3例C,2例D;获得随访患者术后Frankel评分1例D,4例E,与术前相比神经功能改善1～2级.[结论]因气管插管困难和阻塞性肺病,患者术前应进行麻醉科和影像评估,因患者脊柱发育不良,脊柱的内固定常常很困难.     

脊柱骨软骨瘤

目的：脊柱骨软骨瘤很少见，诊断困难，为此本文回顾分析了１９７４年２月～１９９６年１月诊治的９例共１０个脊柱骨软骨瘤。材料与方法：本组成年男性４例、女性３例，少年男、女各１例。年龄平均３５．２岁。所有病变均经病理诊断证实。结果：１０个病变中，位于颈椎４个、胸椎５个、腰椎１个；除１个位于椎体与椎弓交界处外，其余９个均来自椎体附件；５个侵占椎管导致颈脊髓压迫３例、胸脊髓压迫１例、马尾压迫１例；３个累及神经根管致颈或胸神经根压迫３例，１个为无痛性包块。９例中，７例为单纯骨软骨瘤，１例为多发骨软骨瘤病有２个病变，１例骨软骨瘤软骨肉瘤恶变。Ｘ线仅能发现部分病变，且与四肢骨软骨瘤的影像特征不同。ＣＴ对诊断有较大价值。结论：骨软骨瘤好发于椎体附件特别是关节突，容易累及脊髓或神经根，因而对椎管内骨软骨瘤或多发骨软骨病累及脊柱者，应积极手术、彻底切除。     

脊柱骨软骨瘤3例报告附中国文献复习

脊柱骨软骨瘤较少见,１９６９年来我院共收治３例,其中１例为骨软骨瘤病。病变部位：Ｃ４、Ｃ５及Ｔ１２各１例４个病变,压迫脊髓的３个病变均起源于椎板。经手术治疗,两例有脊髓压迫症状者完全恢复,１例瘫痪者随访两年无改善。复习中国所报告的脊柱骨软骨瘤共计３２例３４个病变,平均病程１４个月,年龄３４５岁,男女比为２∶１。脊柱各阶段均有病变报道,以颈胸椎为多,按平均每个椎体发生病变的机会则依次为颈、腰、胸、骶椎。脊椎各部均可发生病变,以椎板、椎体及关节突为多。治疗均采用手术切除。影响预后的主要因素是术前神经功能已受损情况及肿瘤的位置。     

经后路全脊椎整块切除术治疗胸腰椎肿瘤

目的:探讨经后路全脊椎整块切除术(TES)治疗胸腰椎肿瘤的方法及其疗效.方法:2005年1月～2007年7月收治胸腰椎肿瘤患者6例,其中男3例,女3例,年龄20～77岁;Tomita分型,Ⅲ型1例,Ⅳ型3例,Ⅴ型2例;T3 1例,,T8 2例,T9 1例.T11 1例,L1 1例;骨巨细胞瘤1例,椎体单发骨髓瘤1例,转移性腺癌4例;术前脊髓功能Frankel分级B级2例,D级1例,E级3例.均应用改良弧形骨刀行一期后入路全脊椎整块切除术,同时采用钛网植骨/钛网骨水泥前方重建,并联合椎弓根钉内固定系统固定.随访观察手术时间、术中出血量、局部疼痛和脊髓功能的恢复情况,以及肿瘤复发、植骨融合、脊柱稳定性情况.结果:6例患者均顺利完成手术,手术时间200～270min,平均230min;失血量1100～3000ml,平均1400ml.随访6个月～3年,术后近期疗效均较满意,局部疼痛和神经症状均有不同程度改善或缓解.术前VAS评分平均8分,术后平均2分,平均下降6分;术前有脊髓神经功能障碍者中1例由Frankel B级恢复至D级,其余均恢复至E级.1例骨巨细胞瘤于术后15个月局部复发,再次手术;1例胃癌转移瘤患者术后14个月因多器官转移死亡;其余患者至末次随访时存活,植骨融合良好,无钛网移位及脊柱失稳,无断钉、断棒现象,无局部复发.结论:后路全脊椎整块切除术是胸腰椎肿瘤一种有效的手术方法,可改善脊髓神经功能,降低脊柱骨肿瘤局部复发率.     

全脊椎切除及脊柱稳定性重建治疗颈胸段脊柱肿瘤

目的探讨全脊椎切除术及脊柱稳定性重建治疗颈胸段脊柱肿瘤的临床效果。方法回顾性分析2008年3月~2015年4月我院收治的50例行全脊椎切除术及脊柱稳定性重建的颈胸段脊柱肿瘤患者临床资料,术前Frankel脊髓损伤分级:A级2例,B级7例,C级14例,D级22例,E级5例。结果本组患者均顺利完成手术,手术时间为3.4~10.8 h,平均(6.9±1.3)h,术中出血量1 440~2 430 ml,平均(2 050±107)ml,围术期内无死亡,患者伤口愈合良好,疼痛均明显减轻。术后脊髓神经功能Frankel分级为C级3例,D级5例,E级42例,较术前有显著改善(P0.05),患者行走功能亦较术前明显改善(P0.05)。术后随访12个月,所有患者内固定稳定,植骨融合满意。术前伴神经功能损害的9例患者得到完全恢复。有1例骨母细胞瘤和2例甲状腺滤泡型转移癌局部复发。结论根据颈胸段脊柱肿瘤患者的病症特性,实施相应的全脊椎切除术和合理的脊椎稳定性重建,可有效改善患者的脊柱损伤程度和神经功能,临床效果显著,术后并发症发生率低。     

股骨内生软骨瘤与Ⅰ级软骨肉瘤的诊治要点

目的比较股骨内生软骨瘤与低度恶性软骨肉瘤的CT与MRI影像特征,为临床诊断与治疗提供参考。方法回顾性分析自2008-01—2018-04诊治6例股骨内生软骨瘤与6例股骨Ⅰ级软骨肉瘤,行病灶刮除植骨术。术前测量CT图像上病灶的最大直径,观察CT图像上是否出现钙化斑、有无股皮质破坏,观察MRI图像上是否有髓腔内扇贝样改变。结果 12例均获得随访,股骨内生软骨瘤组随访时间平均59.5(18～90)个月,股骨Ⅰ级软骨肉瘤组随访时间平均32.3(13～68)个月。所有患者随访期间均未复发,患肢髋、膝关节功能恢复良好。股骨内生软骨瘤组CT图像上病灶最大直径为(4.08±3.31)cm,股骨Ⅰ级软骨肉瘤组最大直径为(6.07±2.97)cm。股骨内生软骨瘤组6例CT图像上均存在钙化斑,3例CT图像上存在骨皮质破坏,MRI图像上均无髓腔内扇贝样改变。股骨Ⅰ级软骨肉瘤组4例CT图像上均存在钙化斑,1例CT图像上存在骨皮质破坏,5例MRI图像上有髓腔内扇贝样改变。结论股骨内生软骨瘤与Ⅰ级软骨肉瘤的术前影像学鉴别诊断较为困难,病灶刮除植骨术是安全有效的治疗方法。     

脊柱浆细胞瘤的诊断与治疗

目的 总结脊柱浆细胞瘤外科诊断与治疗的临床经验.方法 回顾性分析1984年12月至2007年12月首诊并经手术治疗的脊柱浆细胞瘤27例患者的临床资料,男20例,女7例;年龄35～60岁,平均47.7岁.均主诉受累节段附近疼痛,9例伴放射痛,18例合并脊髓功能损害(Frankel B级1例、C级3例、D级14例).术前17例行CT引导下经皮穿刺脊柱病灶活检,病理均报告为浆细胞瘤.27例均经术后病理证实诊断.根据肿瘤侵犯部位选择前路、后路或前后联合入路手术.均行放疗和(或)辅助化疗.结果 5例失访,22例随访7～102个月,平均37.4个月.除1例于术后102个月死亡外,均存活并恢复正常工作与生活.术后局部疼痛或放射痛均缓解、括约肌功能障碍均恢复正常.术前脊髓功能B级、C级者于术后1年恢复至E级;D级14例中2例术后1周仍为D级,之后失访,12例恢复至E级.结论 CT引导下经皮穿刺脊柱病灶活检对诊断脊柱浆细胞瘤具有重要价值.对脊柱浆细胞瘤患者行选择性手术治疗可有效缓解疼痛,改善神经功能,恢复脊柱稳定,为进一步放疗和化疗创造有利条件.正规的放疗和化疗是巩固手术疗效的重要手段.     

强直性脊柱炎合并Andersson病损的诊断及手术治疗

目的探讨强直性脊柱炎合并Andersson病损的发病机制、临床诊断特点及手术治疗效果。方法回顾性分析自2008-01—2015-12行后路手术治疗的14例强直性脊柱炎合并胸腰段Andersson病损。比较手术前后疼痛VAS评分、ODI指数、全脊柱后凸Cobb角、脊髓神经功能Frankel分级。结果 14例均获得随访,随访时间平均23(6~60)个月。术前10例存在脊髓损伤,术后1例脊髓神经功能由C级改善至D级,2例由C级改善至E级,7例由D级改善至E级;术后仅1例存在脊髓损伤,13例脊髓神经功能正常;术后脊髓神经功能较术前明显改善,差异有统计学意义(P0.05)。末次随访时疼痛VAS评分、ODI指数较术前明显降低,差异有统计学意义(P0.05)。术后3 d全脊柱后凸Cobb角较术前明显减小,差异有统计学意义(P0.05);末次随访时全脊柱后凸Cobb角与术后3 d比较差异无统计学意义(P0.05)。结论采用后路手术治疗强直性脊柱炎合并Andersson病损可明显减轻患者胸背部疼痛,改善后凸畸形,促进脊柱节段融合,解除神经压迫,恢复神经系统功能,效果较为满意。     

颈椎骨软骨瘤的临床诊治

[目的]探讨颈椎骨软骨瘤的分类、发病特点、临床表现、影像学特征、诊断及治疗选择。[方法]2006年6月～2019年2月,本科共收治5例颈椎骨软骨瘤患者,均行早期手术治疗,术后进行时间不等的随访,评估患者神经功能恢复情况,以观察术后效果。[结果] 5例均获得随访,随访时间7～15个月,均取得理想效果。[结论]因颈椎解剖结构复杂,应采取更为积极的治疗态度,无论向椎管外生长的单发骨软骨瘤还是向椎管内生长的所有骨软骨瘤,发现后均应积极手术切除,以避免肿瘤过大导致切除困难或神经损害加重,甚至复发、恶变,对于复发者应再次行完整切除。     

纳米羟基磷灰石/聚酰胺66支撑体重建肿瘤切除术后脊柱稳定性的初步应用

目的探讨纳米羟基磷灰石/聚酰胺66(nano-hydroxyapatite/polyamide 66,n-HA/PA66)支撑体在脊柱肿瘤切除后脊柱稳定性重建中的安全性及临床疗效。方法 2008年1月-2009年12月,对11例脊柱肿瘤行前路或前后联合入路肿瘤切除、n-HA/PA66支撑体椎间植入重建脊柱稳定性。男6例,女5例;年龄16～61岁,平均44.5岁。病程2～14个月,平均6.8个月。其中转移癌5例,骨巨细胞瘤2例,骨母细胞型骨肉瘤1例,软骨肉瘤1例,非霍奇金淋巴瘤2例。病变位于颈椎2例,胸椎6例,腰椎3例。术前Frankel神经功能分级为A级1例,B级3例,C级2例,D级2例,E级3例。结果手术切口均Ⅰ期愈合,未见严重术中及术后并发症。3例肝癌转移及1例肺癌转移患者于术后5～9个月因原发疾病死亡;余7例术后随访时间10～18个月,平均14.4个月。术后3个月Frankel神经功能分级较术前不同程度改善。X线片及三维CT示n-HA/PA66支撑体无明显塌陷、下沉、断裂及移位,内固定物位置良好。术后6个月存活的10例患者植骨均达骨性融合。术前病椎邻近上、下椎间高度为(97.5±15.4)mm,术后3个月和末次随访时分别为(110.5±16.1)mm和(109.4±16.2)mm,与术前比较差异均有统计学意义(P<0.05);术后3个月与末次随访比较,差异无统计学意义(P>0.05)。2例前路经胸手术患者术后出现双侧胸腔积液,予以穿刺抽液及胸腔闭式引流术后痊愈。随访期间1例L3椎体骨巨细胞瘤术后7个月原位复发,1例T11椎体软骨肉瘤患者术后14个月在L3椎体复发,均再次行肿瘤切除、n-HA/PA66支撑体植入重建术,术后随访无复发,原手术部位达骨性融合。结论 n-HA/PA66支撑体具有良好的安全性和椎间支撑稳定作用,植骨融合满意,是一种较理想的新型脊柱前路重建方法。     

On spinal osteochondromas.

Osteochondromas (or osteocartilaginous exostoses) make up about 30% to 40% of benign bone tumors. Most are solitary lesions but some are multiple, usually with autosomal dominant inheritance. From 1% to 4% of osteochondromas occur in the spine, where they can cause a variety of signs and symptoms, including those of spinal cord or spinal root compression. The authors present five patients with osteochondromas of the spine and review the findings together with those of over 130 cases reported since 1907. The cases were divided into: 1) spinal osteochondromas in patients with multiple osteochondromas, and 2) solitary osteochondromas occurring in the spine. The age (mean +/- standard error of the mean) of patients in the first group was 21.6 +/- 1.8 years compared to 30.0 +/- 2.1 years for those in the second group (p less than 0.02). There was a significant male predominance overall (M:F = 2.5:1; p less than 0.0005). In both groups, one-half of the lesions involved the cervical spine. Symptoms are caused by pressure on adjacent structures. Spinal cord compression was reported more than twice as frequently in the multiple osteochondroma group as in the single osteochondroma group (77% vs 33%; p less than 0.0005). Computerized tomography (CT) is the imaging procedure of choice. In both groups, the majority of surgically treated patients (90% and 88%, respectively) improve, with about three-quarters of the improved patients having no residual disease or only minor deficits.     

Osteochondroma of C7 vertebra presenting as compressive myelopathy in a patient with nonhereditary (nonfamilial/sporadic) multiple exostoses

Introduction Osteochondromas are most commonly found in the appendicular skeleton. They occur less frequently in the spine and compression of the spinal cord is very rare. To the best of our knowledge, this is the first report of an osteochondroma arising from C7 vertebra presenting with compressive myelopathy in a patient with nonhereditary multiple exostoses. Our purpose is to report this rare presentation and its successful management, and to highlight the clinico-radiological features of this treatable condition.Materials and methods A 20-year-old male with nonhereditary exostoses presented with gradual onset weakness in bilateral lower limbs, which had rapidly progressed to complete paraplegia over 1 month. The tumor was effectively treated by surgical excision along with spinal decompression. The diagnosis was confirmed by histopathological evidence complemented by clinico-radiological studies.Results There has been a complete functional recovery without any evidence of recurrence at last follow-up at 2 years.Conclusion Compressive myelopathy due to an osteochondroma arising from C7 vertebra in a case with nonhereditary multiple exostoses is being reported for the first time. Both CT and MRI demonstrated the origin, size, extent and relationship of the tumor to the vertebral and neural elements. Complete recovery of functions after surgical decompression was achieved in this case. An osteochondroma of spine must always be considered in all patients with multiple exostoses who have spine pain or develop neural deficit.     

Osteochondroma of the cervical spine--a surprising finding in a liver transplanted patient with polyneuropathy and polyradiculitis: case report

BACKGROUND: Osteochondroma of the spine is a rare condition. We report a case of a patient with a cervical osteochondroma presenting with a polyneuropathy and polyradiculitis simultaneously. CASE DESCRIPTION: In a liver-transplant patient with progressive neurological deficits a polyneuropathy and a polyradiculitis were diagnosed. Eventually the patient became quadraparetic and an osteochondroma compressing the cervical spinal cord was found. The patient's neurological symptoms markedly improved after gross total tumor resection and antibiotic therapy. CONCLUSIONS: Review of the literature reveals this case to be an unusual presentation of a cervical osteochondroma, its diagnosis being delayed because of concomitant neurological diseases.     

Solitary osteochondroma arising from the thoracic facet joint--case report

A 15-year-old male presented with pain in the back and paresthesia and weakness of both lower limbs progressing for 6 months. Magnetic resonance imaging revealed a mass lesion occupying the spinal canal at the T-10 to T-11 levels, which had severely compressed the cord. At surgery, a firm and cartilaginous tumor originating from the facet joint was radically excised. The patient showed rapid neurological recovery following the surgery. Histological examination revealed that the lesion was osteochondroma. Such lesions are extremely rare in the lower thoracic spine and osteochondroma arising from the thoracic facet joint is unique.     

Primary neoplasms of the thoracic and lumbar spine. An analysis of 29 consecutive cases

Primary osseous neoplasms of the thoracic and lumbar spine are uncommon lesions. Between 1965 and 1982, of 1971 patients with musculoskeletal neoplasms, only 29 (1.5%) had primary osseous tumors in these locations. There were eight children and 21 adults. Back pain was the most common complaint in 25 patients (86%), and neurologic symptoms or deficits were present in 16 patients (55%). All lesions were visible on routine spine roentgenograms, while computed tomography and myelography demonstrated spinal canal encroachment and extradural spinal cord compression in 19 patients (66%). The histologic diagnoses included 11 benign and 18 malignant lesions. Benign lesions occurred predominantly in children and malignant tumors in adults. Treatment was individualized, based on the histologic diagnoses. Twenty-two patients had surgical resection of their lesions. Laminectomy without stabilization and arthrodesis resulted in late instability and neurologic deterioration in three of seven patients (43%) with malignant lesions. Resection and decompression combined with arthrodesis did not predispose to late instability. Twenty-one patients were followed for a mean of 4.1 years (range, two to 14 years). Eight patients died from malignant disease between one month and seven years after diagnosis.     

Osteoblastoma of the spine.

Osteoid osteomas and osteoblastomas have similar histologic characteristics, although their clinical course in the spine may be significantly different. At the authors' institution, spinal osteoblastomas constituted 46% (30/65) of all osteoblastomas treated. Sixteen of the lesions occurred in the lumbar spine (53%), eight in the thoracic spine, and six in the cervical spine. In all regions of the spine, the posterior elements and pedicles were more frequently involved than the vertebral body. Twenty patients had pain or other symptoms for more than 12 months before diagnosis. Six of eight patients had thoracic lesions that demonstrated neurologic involvement. Twelve patients presented with painful scoliosis. Fourteen patients had lesions with well-circumscribed margins confined within the vertebral structure (Enneking Stage 2), and 16 had ill-defined margins with soft-tissue extension (Enneking Stage 3). Well-defined lesions were treated with curettage, with excellent results in 12 of 14 patients. The more extensive lesions were treated by intralesional excision (15/16) and adjuvant radiation therapy (9/16).     

Headache due to an osteochondroma of the axis

We reported a case of a 42-year-old man with a 3-year history of headache due to a spinal osteochondroma. Repeated neurological evaluation, including EEG studies and CT of the cerebrum, revealed no pathology. More recently the patient presented with persistent headache and a slight limitation of neck motion. MRI studies of the cerebrum including the cervical spine showed a high cervical extradural tumor. Additional CT angiography showed a bony tumor suspected of being a spinal osteochondroma. An en bloc resection of the tumor was performed; histological evaluation confirmed the diagnosis. Immediately after intervention, all symptoms disappeared. In most patients with a spinal osteochondroma, the lesion causes no symptoms, or symptoms are aspecific. Therefore, there is often a significant delay between initial complaints and the diagnosis, as in the current case.     

Solitary plasmacytoma in the thoracic spine. Two case reports

Plasmacytoma of the spine is rather common, but solitary occurence is not. We report two cases of solitary plasmacytomas in the thoracic spine. A 72 year old male and a 77 year old male presented with progressive paraparesis. In both cases, magnetic resonance images revealed tumors in the thoracic spine which predominantly occupied the posterior elements of the spine with compression of the spinal cord. Abnormal proteinuria and proteinemia were not detected. The tumors were removed and patients' symptoms improved, the tumors were diagnosed by histopathology to be plasmacytomas. Further neuroradiological studies suggested them to be single lesions, so that the final diagnosis was solitary plasmacytomas. Solitary plasmacytoma should be considered for diagnosis of single spinal lesion even without abnormal proteinemia or proteinuria.     

Osteochondroma in the lumbar spinal canal causing sciatic pain: report of two cases

 A search of the English-language medical literature found only two cases in which expansion of an osteochondroma into the lumbar spinal canal caused sciatica. We report another two cases of spinal nerve root compression by solitary lumbar spinal canal osteochondromas: in a 56-year-old man and a 55-year-old woman with no history of hereditary multiple exostoses. Osteochondromas compressing the spinal nerve root were seen at the inferior articular processes of the lumbar vertebrae by computed tomography (CT), three-dimensional reconstruction of CT scans, myelography, and magnetic resonance imaging. The symptoms disappeared after surgical removal of the lesions. Histopathologic examination confirmed the diagnosis of benign osteochondroma. Received: June 4, 2002 / Accepted: September 1, 2002 Offprint requests to: S. Ohtori     

Osteochondroma of the cervical spine—a surprising finding in a liver transplanted patient with polyneuropathy and polyradiculitis: case report

BACKGROUND

Osteochondroma of the spine is a rare condition. We report a case of a patient with a cervical osteochondroma presenting with a polyneuropathy and polyradiculitis simultaneously.

CASE DESCRIPTION

In a liver-transplant patient with progressive neurological deficits a polyneuropathy and a polyradiculitis were diagnosed. Eventually the patient became quadraparetic and an osteochondroma compressing the cervical spinal cord was found. The patient’s neurological symptoms markedly improved after gross total tumor resection and antibiotic therapy.

CONCLUSIONS

Review of the literature reveals this case to be an unusual presentation of a cervical osteochondroma, its diagnosis being delayed because of concomitant neurological diseases.