胸腰椎椎体骨样骨瘤的临床表现和切除重建策略

目的探讨胸腰椎椎体骨样骨瘤患者的临床表现特点和后路经椎弓根肿瘤切除植骨内固定手术的疗效。方法 2001年1月-2010年6月,收治8例胸腰椎椎体骨样骨瘤患者。男5例,女3例;年龄6～27岁,中位年龄15.5岁。出现症状至就诊时间为2～19个月,平均11.8个月。病灶节段:L2、L5各2例,L3、L4、T8和T10各1例。主要临床表现为腰背部疼痛,1例存在下肢放射痛,4例合并脊柱侧凸。病灶直径0.9～2.0 cm,平均1.6 cm。患者均行后路经椎弓根椎体内病灶刮除、打压植骨、一期内固定手术。结果手术时间70～170 min,平均110 min。术中出血量300～1 400 mL,平均720 mL。术后病理检查均证实为骨样骨瘤。患者切口均Ⅰ期愈合,腰背疼痛和下肢放射痛均完全消退,无并发症发生。术后随访时间12～58个月,平均39个月。随访期间无肿瘤复发及脊柱畸形发生。结论 CT能显示椎体骨样骨瘤低密度瘤巢和周围的骨硬化带,是胸腰椎椎体骨样骨瘤重要影像学检查方法;采用后路经椎弓根椎体内病灶刮除、打压植骨、一期内固定手术可获得较好疗效。

Clinical manifestation and strategy for surgical resection and reconstruction of thoracolumbar vertebral osteoid osteoma

Objective To investigate the clinical manifestation of thoracolumbar vertebral osteoid osteoma and to evaluate the surgical procedure and effectiveness of transpedicular tumor resection and spine reconstruction with posterior pedicle screw system and bone graft.Methods Between January 2001 and June 2010,8 cases of thoracolumbar vertebral osteoid osteoma underwent one-stage transpedicular intralesional excision and bone graft combined with spine reconstruction with pedicle screw system through posterior approach.There were 5 males and 3 females with a median age of 15.5 years(range,6-27 years).Affected segments included T8 in 1 case,T10 in 1 case,L2 in 2 cases,L3 in 1 case,L4 in 1 case,and L5 in 2 cases.All of the cases had back pain,1 had radiating pain of lower extremity,and 4 patients presented with scoliosis.The mean diameter of lesions was 1.6 cm(range,0.9-2.0 cm).Results The mean operation time was 110 minutes(range,70-170 minutes) and the mean blood loss was 720 mL(range,300-1 400 mL).The postoperative pathologic examination showed osteoid osteoma in all cases.All patients achieved healing of the incisions by first intention.Immediate relief of pain was observed after operation in all patients without complication.The patients were followed up 12-58 months(mean,39 months).No local recurrence or spinal deformity was observed during the follow-up.Conclusion CT can show a low attenuation nidus with central mineralization and varying degrees of perinidal sclerosis,so it has great value for final diagnosis of thoracolumbar vertebral osteoid osteoma.One-stage transpedicular intralesional excision supplemented by impaction bone graft and combined posterior pedicle screw stabilization is a safe and effective treatment.