脊柱病变为主的骨髓瘤的诊断和外科治疗

[目的]探讨以脊柱病变为主的骨髓瘤的的诊断方法和外科治疗的指征、方式及效果。[方法]对本科自1996。2004年收治的13例以脊柱病变为主的骨髓瘤患者的临床表现、辅助检查及外科治疗情况进行回顾分析。本组资料13例患者，男性5例，女性8例，平均47．67岁。行X线、CT、MRI、ECT、术前／术中病理活检等检查，均行外科手术治疗：经前路椎体肿瘤切除、钛网植骨或骨水泥椎体植入、钢／钛板内固定7例，经后路全脊椎切除、钛网植骨、椎弓根钉固定4例，联合入路肿瘤切除、前路钛网植入、钛板内固定、后路经椎弓根固定2例。[结果]术后患者疼痛症状明显缓解，脊髓或神经根压迫症状改善，生活质量提高，2例截瘫患者Frankel分级分别由B级、C级变为D级，患者均获随访，平均随访36．75个月，1例复发，3例死亡。[结论]X线检查可提供诊断线索，CT与MRI在诊断和鉴别诊断中有重要作用，ECT检查可发现全身多个病灶，病理活检是可靠的诊断方法，选择性手术治疗可使患者症状得到明显持久缓解，须结合化疗、放疗等其他治疗，才能得到最好的治疗效果。

Diagnosis and surgical treatment of spinal myeloma

[ Objective] To discuss the diagnosis and surgical treatment of spinal myeloma, [ Method] To make a retrospective analysis of cliniacal history and operation results of 13 patients with spinal myeloma from 1999 to 2004. There were 5 males and 8 females with average age of 47.67 years. They were diagnosed by X-ray, CT, MRI, ECT and biopsy. Resection of tumor was performed in all cases, of which 7 cases was through anterior approach, 4 cases through posterior approach, 2 cases through combined approach. [ Result] The pain was decreased and neurological function was improved in all cases after the surgery. Three death and one recurrence was found during the follow-up time. [ Conclusion] X-ray, CT and MRI are essential for diagnosis, ECT may help found multiple lesions, biopsy is reliable diagnosable method. Surgery can relived the symptoms obviously, but should be associated with adjuvant treatments.