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目的探讨骨原发性恶性淋巴瘤的临床特征及其治疗效果。方法回顾性分析我院1995年4月至2003年10月收治的经病理检查证实的11例骨原发性恶性淋巴瘤的病例资料,其中骨盆3例,胸椎和腰椎各2例,颅骨、左肱骨上端、左尺骨近端和左股骨转子部各1例。疼痛为共同表现,1例腰椎病变者有神经根受损症状。X线片示主要为溶骨性改变。病理类型主要为弥漫性大B细胞性淋巴瘤。治疗主要采用局部放疗和全身化疗,1例腰椎病理性压缩性骨折者行经皮穿刺椎体成形术,1例左股骨转子部病变者行瘤段切除人工髋关节置换术。结果随访1～8年,平均2.5年,1年、3年、5年生存率分别为100%(11/11)、66.7%(2/3)、50.0%(1/2),1例腰椎弥漫性大B细胞型Ⅲ期患者1年后出现全身多处转移死亡,且随着临床分期增高,3、5年生存率降低。结论骨原发性恶性淋巴瘤临床少见,治疗应以放、化疗等综合治疗为主,原发灶若为主要负重骨应辅以手术治疗预防病理性骨折的发生。
Objective To investigate the clinical features and treatment of primary malignant lymphoma of bone. Methods The clinical data of 11 cases of primary malignant lymphoma confirmed by pathology from April 1995 to October 2003 in our hospital were retrospectively analyzed. Among them, 3 cases were pelvis, 2 cases were thoracic and lumbar, 2 cases were skull, The upper humerus, left ulnar and left femoral trochanter in 1 case. Pain as a common manifestation, 1 case of lumbar lesions have nerve root damage symptoms. X-ray film is mainly osteolytic changes. The main pathological type of diffuse large B cell lymphoma. The treatment mainly used local radiotherapy and systemic chemotherapy, 1 case of lumbar pathological compression fracture percutaneous vertebroplasty, 1 case of left femoral trochanteric lesion underwent resection of the total hip arthroplasty. Results The follow-up ranged from 1 to 8 years, with an average of 2.5 years, 1 year, 3 years and 5 years survival rates of 100% (11/11), 66.7% (2/3) and 50.0% (1/2) One year after diffuse large B cell type III patients died of systemic multiple metastasis, and with the clinical stage increased, 3, 5-year survival rate decreased. Conclusion The primary malignant lymphoma of bone is rare. The treatment should be mainly radiotherapy and chemotherapy. The primary tumor should be supplemented with surgical treatment to prevent the occurrence of pathological fractures.