颈椎孤立性浆细胞瘤的外科干预及放疗结果分析  

Surgical intervention and radiotherapy outcome of solitary plasmacytoma of cervical spine

作　　者：黄稳定[1] 冯大鹏[1] 肖建如[1] 黄权[1] 郑伟[1] 吴志鹏[1] 周振华[1] 杨兴海[1] 谢宁[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海200003

出　　处：《中华外科杂志》2010年第9期697-701,共5页Chinese Journal of Surgery

摘　　要：目的 探讨颈椎孤立性浆细胞瘤的临床特点、治疗方法及结果.方法 回顾性分析我科1995年1月至2007年12月收治的23例颈椎孤立性浆细胞瘤患者的临床资料,其中男性16例,女性7例,年龄32～76岁,平均56岁.23例患者除2例仅行单纯放疗外,余21例均行手术治疗.依据脊柱肿瘤WBB分期,采取全椎体切除6例,附件切除4例,矢状切除3例,全椎节切除8例,手术病例采用前路、后路或前后联合入路.脊柱重建方式采取自体髂骨植骨和颈前路钛板、钛网骨水泥内固定或前后联合植骨融合内固定,术后均行辅助放疗.结果 23例患者获得随访,随访时间24.0～143.0个月,平均64.7个月.患者术后颈部疼痛症状明显好转,神经压迫症状消失或得到不同程度的改善,术后3个月患者神经功能Frankel分级平均有1～2个级别的改善.内固定位置及颈椎稳定性良好,无脊柱失稳现象,植骨融合率100%.随访期内有6例局部复发,且进展为多发性骨髓瘤（MM）,死亡3例.2例未手术者分别于确诊后1年及1.5年进展为MM,转血液科进一步化疗.15例患者术后辅助放疗后一般情况良好,随访期内复查M蛋白、骨髓穿刺等检查均未见明显异常,单光子发射计算机断层扫描或PET-CT检查未发现其他部位骨骼有新发病灶.结论 颈椎孤立性浆细胞瘤临床较为少见,对于骨质破坏明显、椎节不稳或神经功能障碍者,首选手术治疗;术后辅助放疗能明显降低局部复发率及进展为MM的可能性,进展为MM者应根据相应化疗方案进行化疗,预后相对较差.Objective To study the clinical features, treatment methods and outcome of solitary plasmacytoma of cervical spine. Methods From January 1995 to December 2007, the data of 23 cases with solitary plasmacytoma of cervical spine was analyzed. There were 16 males and 7 females （ mean age 56 years, range： 32-76 years）. Two cases underwent radiotherapy alone and 21 patients received surgery. According to WBB staging system, surgical procedures were defined as total or subtotal resection （6 cases）, appendix resection （4 cases）, sagittal resection （3 cases） and total spondylectomy （8 cases）. All surgical cases were managed using an anterior approach, posterior approach or combined anterior and posterior approach. The cervical spinal reconstruction was achieved through anterior cervical titanium plate and titanium mesh cage filled with auto iliac graft or bone cement, or anterior and posterior combined instrumented fusion. All patients received radiotherapy as adjunctive therapy. Results Follow-up of the 23 cases lasted 24. 0-143.0 months （mean： 64. 7 months）. Neck pains obviously improved, and nerve compression symptoms disappeared or improved after surgery. Neurological function improved by 1-2 grades based on Frankel grading system All the internal fixations were fused well and stability of the cervical spine was fine and no spine instability could be seen in our series. The bone graft fusion rate was 100%. During the follow-up period, 6 surgical cases had local recurrence and finally progressed to multiple myeloma（MM） and 3 died. Two cases without surgical treatment progressed to MM in 1 year and 1.5 years after confirmed diagnosis. They were given systemic chemotherapy. The other 15 patients had disease-free survival and after surgery and adjunctive radiotherapy. Obvious abnormity were not found in such examinations as M protein, bone marrow aspiration and emission computed tomography or PET-CT examinations. Conclusions Solitary plasmacytoma of cervical spine is rarely seen clinically.

关 键 词：浆细胞瘤 颈椎 手术 放疗 

分 类 号：R687.3[医药卫生—骨科学]