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目的:探讨脊柱原发软骨肉瘤的治疗方法及预后。方法:对1993年～2005年收治的16例脊柱原发软骨肉瘤进行回顾性分析。男9例,女7例;年龄19～69岁,平均44岁。累及胸椎7例,腰椎2例,胸腰椎多发1例,骶椎6例。8例伴神经损伤症状,Frankel分级C级3例,D级5例。1例骶骨巨大软骨肉瘤因去分化改变采取化疗,因化疗无效患者放弃治疗出院;其余15例均行手术治疗,根据肿瘤部位不同采取前路、后路或前后路联合肿瘤切除术,并予以相应重建方式。结果:15例手术患者术后随访1～13年,平均6.2年。1例死于术后肺栓塞。术前有神经症状者中1例Frankel C级患者术后无改变,其余7例(87.5%)术后Frankel分级均改善1个等级。2例出现去分化改变,于术后12个月内死亡。术后复发7例,占47%(7/15),复发1次者4例(4/15,27%),复发2次以上者3例(3/15,20%)。除1例去分化软骨肉瘤外,其余6例每次复发后均行手术再次切除。至今存活12例,生存时间1～19年,平均7.5年。结论:对于脊柱原发软骨肉瘤,首选广泛性切除,对难以达到广泛切除者,应尽量争取彻底切除;对复发肿瘤,仍应争取再次手术并尽可能彻底切除,可达到一定的生存时间及功能保留。
Objective: To explore the treatment and prognosis of primary chondrosarcoma of the spine. Methods: A retrospective analysis of 16 cases of primary chondrosarcoma from 1993 to 2005 was conducted. 9 males and 7 females; aged 19 to 69 years old, average 44 years old. Involved in thoracic 7 cases, 2 cases of lumbar, thoracic and lumbar multiple cases in 1 case, 6 cases of sacral. 8 cases with symptoms of nerve injury, Frankel grading C grade in 3 cases, D grade in 5 cases. One case of giant chondrosarcoma of the sacrum was treated with chemotherapy because of dedifferentiation, and patients who were ineffective due to chemotherapy were given up for treatment and discharged. The remaining 15 cases underwent surgical treatment. The anterior, posterior or anterior and posterior approaches were performed according to the tumor location, Reconstruction. Results: Fifteen patients were followed up for 1 ~ 13 years with an average of 6.2 years. One patient died of postoperative pulmonary embolism. One patient with Frankel C grade preoperative neurological symptoms had no change after operation, and the remaining seven patients (87.5%) had an improvement of one grade after Frankel classification. 2 cases of dedifferentiation change, died within 12 months after surgery. Seven cases were recurrence, accounting for 47% (7/15), 4 cases (4/15%, 27%) after recurrence, and 3 cases (3/15%, 20%) after recurrence. In addition to one case of dedifferentiated chondrosarcoma, the remaining 6 cases were resected again after surgery. So far, 12 cases survived, survival time of 1 to 19 years, an average of 7.5 years. Conclusion: For the primary chondrosarcoma of the spine, the first choice of extensive excision, it is difficult to achieve extensive excision, should strive for complete resection; recurrence of the tumor, surgery should be strived and as completely resected as possible, to achieve a certain survival time and function Keep.