少儿脊柱嗜酸性肉芽肿保留椎体骨骺肿瘤切除手术的临床初步研究  

The preliminary clinical study of reservation vertebral osteoepiphysis during eosinophilic granuloma resection in children

作　　者：石磊[1] 王臻[1] 郭征[1] 李靖[1] 栗向东[1] 范宏斌[1] 付军[1] 李晓康[1] 陈国景[1] 吴智钢[1] 

机构地区：[1]第四军医大学西京医院骨科 陕西省西安市长乐西路15号,710032

出　　处：《中国脊柱脊髓杂志》2015年第1期34-38,共5页Chinese Journal of Spine and Spinal Cord

摘　　要：目的：探讨少儿脊柱嗜酸性肉芽肿（EG）保留椎体骨骺肿瘤切除手术的临床效果及其对少儿脊柱生长发育的影响。方法：2008年1月～2013年12月共收治6例病理诊断为脊柱嗜酸性肉芽肿的少儿患者,男5例,女1例;年龄9.8±2.9岁（6～13岁）。胸椎3例（T8-9、T11、T11-12）,腰椎3例（L2、L4、L5各1例）,患者均有腰背部疼痛不适症状,并在夜间加重,X线片示肿瘤侵犯椎体,均存在不同程度的压缩变形,同时有1例患者（T11-12者）并发轻度的后凸畸形。均采用脊柱后路经椎弓根椎体肿瘤切除术,保留椎体骨骺,植骨后,用内固定轻度撑开并恢复部分椎体间隙。所有患者术后均给予长春新碱化疗4次。应用VAS评分评价患者术前、术后2周疼痛变化情况。观测压缩椎体前缘高度术前及术后1年变化情况,同时观察后凸畸形变化情况。结果：6例患者随访2.3±0.9年（1～4年）,未见复发及脊柱畸形。患者疼痛评分由术前5.5±1.2分,术后2周时下降到1.3±0.4分（P〈0.05）;压缩椎体前缘平均高度术前0.4±0.1cm,术后1年增加到1.1±0.2cm（P〈0.05）,1例并发胸椎后凸畸形患者,后凸角度由术前30°,术后1年随访时下降致20°。结论：少儿脊柱EG,通过保留脊柱椎体骨骺的手术方法,可以在保证患儿治疗效果的前提下,最大限度减少手术对于脊柱生长发育的影响。Objectives： To discuss the effect of the development of eosinophilic granuloma（EG） resection by reserving vertebral osteoepiphysis in children. Methods： From January 2008 to December 2013, 6 EG patients including 5 males and 1 female aged 6-13（average 9.8 ±2.9） years were included in this series. The tumors were sited in thoracic spine（T8-9; T11; T11-12） in 3 cases and in lumbar spine（L2; L4; L5） in 3 cases. All the patients presented with the low back pain and serious night pain. The X-ray indicated that the vertebral bodies infiltrated more or less, and one patient had slight kyphosis in T11-12. All the patients underwent posterior operation（resection of the tumor through pedicle, reservation of vertebral osteoepiphysis, reconstruction of the spine stability by pedicle screws with slight distraction）. After that, all the patients accepted Vincristine chemotherapy for 4 times. The pain level was evaluated before and 2 weeks after operation by VAS scores.Anterior body heights of the diseased vertebrae were recorded before and 1 year after operation, meanwhile the kyphosis was also observed. Results： 6 patients were followed up for 1-4 years, averaged 2.3 years. Recurrence and spine malformation were not found in all patients. The VAS scores decreased significantly（P〈0.05）, from 5.5±1.2（pre-operation） to 1.3±0.4（2 weeks post-operation）. The height of the anterior body of diseased vertebrae increased significantly（P〈0.05）, from 0.4±0.1cm（pre-operation） to 1.1±0.2cm（one year after operation）. The kyphosis angle decreased from 30°（pre-operation） to 20°（one-year after operation）. Conclusions：EG resection while reservation of vertebral osteoepiphysis in children was effective and safe, which can reach the best spine profile, but not intervene the growth and development of spine to the great extend.

关 键 词：骨肿瘤 脊柱肿瘤 骨骺 嗜酸性肉芽肿 

分 类 号：R738.1[医药卫生—肿瘤]