摘要
目的：探讨脊柱多骨型纤维异常增殖症（polyostotic fibrous dysplasia, PFD）的治疗方法及疗效。方法：回顾性分析北京大学第三医院骨科2005年1月至2010年12月收治的脊柱PFD患者共4例，男性3例，女性1例。年龄分别为 53、17、32、38岁，2例行术前CT引导下穿刺活检，另2例有既往病理检查结果。患者均有局部持续性疼痛，视觉模拟量表评分法（visual analogue scale,VAS）评分为3 ~ 5分，均有病理性骨折，3例患者伴有神经功能损害。4例患者的术式分别为病灶切除、颈胸段后路固定融合术;复位、枕颈固定植骨融合术；椎体成形术（vertebroplasty, VP）；VP、胸椎后路减压固定融合术。结果：所有患者手术后病理诊断均证实为纤维异常增殖症。手术时间分别为420、150、120、300 min，出血量分别为3 400、500、200、2 000 mL，分别随访84、24、34、12个月，所有患者症状缓解，无手术相关并发症，随访期间未见病灶复发或进展，未见影像学改善表现（溶骨区成骨或病变周围骨皮质增厚）。结论：脊柱PFD少见，多发生于成年，传统的病灶切除手术可靠、有效，而VP创伤更小。对于疼痛及病理性骨折的患者，可仅行VP；合并神经功能损害的患者可进行有限的减压、稳定，辅以VP。
To discuss treatments of spinal polyostotic fibrous dysplasia （PFD） and their clinical outcomes. Methods： A group of spinal PFD patients treated in orthopaedic department of Peking University Third Hospital from January 2005 to December 2010 was retrospectively reviewed. There were 3 males and 1 female. The age was 53, 17, 32, 38 years, respectively. Two cases underwent preoperative CT-guided biopsy and the other two had previous pathologic results. All the patients complained localized pain and VAS （visual analogue scale） ranged from 3 to 5. All the cases had pathologic fractures and 3 cases had neurological impairment. The surgical procedures for each patient were as follows： lesion resection combined with cervicothoracic fixation and fusion; reduction combined with occipitocervical fixation and fusion; vertebroplasty （VP）; VP combined with posterior decompression and fixation. Results： Fibrous dysplasia in each patient was confirmed by postoperative pathological examination. The operation time was 420, 150, 120, 300 minutes and blood loss was 3 400, 500, 200, 2 000 mL. The follow-up period was 84, 24, 34, 12 months. The primary symptoms were fully relieved without any surgery related complication. There was no symptom recurrence or lesion progress during the follow-up. No signs of radiological improvements （filling of lytic lesion, cortical thickening, or both） were detected. Conclusion： Spinal PFD is a rare disease and mostly affects adults. Conventional excision therapy is an effective and reliable treatment for spinal PFD, but vertebroplasty is less invasive. VP alone might be more appropriate for patients complaining only pain symptoms and/or with pathologic fractures. VP combined with limited decompression and stabilization may be more suitable for patients with neurological deficits.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2013年第6期950-955,共6页
Journal of Peking University:Health Sciences
关键词
纤维发育不良
多骨
脊柱
椎体成形术
Fibrous dysplasia, polyostotic, Spine, Vertebroplasty
