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目的基于成人脊柱良性肿瘤手术治疗经验,探索儿童脊柱良性肿瘤的手术治疗方法及其疗效。方法回顾性分析我院2009年5月至2015年5月收治的接受手术治疗的儿童脊柱良性肿瘤患者22例,男13例,女9例;年龄2~14岁,平均(9.2±3.7)岁。颈椎5例,胸椎6例,腰椎9例,胸腰椎多发2例。其中前路(3例)采取颈椎椎体次全切,植骨融合内固定术,后路(19例)采取刮除植骨内固定手术,对于椎体肿瘤注意尽量保留病椎上下终板,保留骨骺。结果本组病例无失访,随访1~5年,平均(3.1±1.2)年;除1例出现复发,其余患者术后局部疼痛症状在术后2周内明显好转,VAS疼痛评分由术前的(5.8±1.2)分下降至术后2周时的(1.7±0.8)分(P<0.05);患者术后神经功能均有不同程度改善,其中神经功能Frankel分级2例由C级恢复至E级,10例由D级恢复至E级,其余患儿无神经功能障碍。其中并发扁平椎改变患儿8例,病变椎体高度由术前(0.5±0.1)cm到术后1年增加到(1.2±0.3)cm(P<0.05)。结论在儿童脊柱良性肿瘤切刮除手术治疗中,如果能对脊柱椎体骨骺进行一定的保留,同时仅行有限节段的脊柱融合治疗,内固定的早期取出,都有利于减少手术对儿童脊柱生长发育的影响。
Objective To explore the surgical treatment of benign tumors of the spine and its curative effect based on the experience of surgical treatment of adult benign tumors of the spine. Methods A retrospective analysis of 22 patients with benign spinal tumors underwent surgery in our hospital from May 2009 to May 2015. There were 13 males and 9 females with a mean age of 9.2 ± 3.7 years . 5 cases of cervical spine, 6 cases of thoracic spine, 9 cases of lumbar spine and 2 cases of thoracolumbar spine. Among them, anterior approach (3 cases) was performed subtotal cervical vertebrectomy and bone graft fusion and internal fixation, and posterior approach (19 cases) was performed with curettage and bone graft fixation. As for vertebral body tumors, Keep epiphysis. Results The patients were followed up for 1 to 5 years with an average of (3.1 ± 1.2) years. All cases except one showed recurrence. The postoperative local pain symptoms in the remaining patients were significantly improved within 2 weeks after operation. The VAS pain score was significantly lower than that before operation (5.8 ± 1.2) points to (1.7 ± 0.8) points at 2 weeks after operation (P <0.05). The neurological function of the patients was improved to some extent after operation. The Frankel grade of neurological function recovered from grade C to Grade E, 10 cases recovered from grade D to grade E, the remaining children without neurological dysfunction. Among them, 8 cases were complicated with flattened vertebral changes. The height of the vertebral body increased from (0.5 ± 0.1) cm to (1.2 ± 0.3) cm before surgery (P <0.05). Conclusion In the surgical treatment of benign tumors in children with splenectomy, if the vertebral epiphysis can be retained, and only limited segmental spine fusion, internal fixation of the early removal, are conducive to reducing the operation of the spine of children The impact of growth and development.