软骨肉瘤是一种少见的骨与软组织恶性肿瘤,好发于骨盆和四肢长骨,发生于颈椎的软骨肉瘤十分稀少,同时侵犯前后柱结构的更为罕见[1-3].目前根治性外科手术切除是治疗脊柱软骨肉瘤的首选[4].由于颈椎解剖学的特点,目前颈椎软骨肉瘤的治疗仍存在很大的挑战.本文报道1例前-后路联合入路C7颈椎次全切除治疗高级别软骨肉瘤的临床效果,并结合文献分析手术方式和入路的选择,报告如下.

患者,女,44岁,因发热3 d于2017年11月26日至广西医科大学第一附属医院就诊.患者2个月前因重型再生障碍性贫血Ⅱ型在我院行非亲缘异基因造血干细胞移植术.查体:反复发热,最高体温39. 5 ℃.

锁骨嗜酸性肉芽肿是一种少见的嗜酸性肉芽肿类型,影像学常表现为溶骨性破坏,临床上容易出现误诊.本文报道1例曾在外院误诊为恶性肿瘤的锁骨嗜酸性肉芽肿病例,并结合文献复习,对其发病特点、诊断与鉴别诊断、治疗方式进行总结,为该病的诊疗常规提出建议.

Abstract This study aimed to determine the impact of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) on the prognosis of nasopharyngeal carcinoma (NPC) before and after intensity modulated radiotherapy (IMRT). Pre/post-treatment and changes in inflammatory biomarker levels of 207 patients who were diagnosed with NPC and received IMRT between January 2012 and December 2014 were analyzed, and the cellular biomarker analyses were from patient blood. ROC (receiver operating characteristic) analysis was used to decide the optimal cutoff values of NLR and changes in NLR (ΔNLR) and PLR (ΔPLR). The Kaplan–Meier and logarithmic rank methods were used to compare overall survival times between groups. Univariate analysis was used to investigate the effects of age, gender, histology, Karnofsky performance score (KPS), TNM stage, clinical stage, course of disease and lymphocyte, neutrophil and platelet counts as well as alkaline phosphatase (ALP) levels on the prognosis of NPC. The independent predictors of OS were determined by Cox multivariate regression analysis. The optimal cut-off values of NLR, PLR, ΔNLR and ΔPLR were 2.49, 155.82, 1.80, and 100.00, respectively. These were used to classify patients into high (NLR > 2.49) and low NLR groups (NLR < 2.49); high (PLR>155.82) and low (PLR < 155.82) PLR groups; high (ΔNLR>1.80) and low ΔNLR groups (ΔNLR < 1.80); high (ΔPLR > 100.00) and low ΔPLR groups (ΔPLR < 100.00). TNM stage, clinical stage and ALP levels were highly correlated with high NLR and PLR. Cox multivariate regression analysis suggested that the ΔNLR (HR = 2.89, 95% CI: 1.33∼2.78) was independent of the characteristics for NPC. As a novel inflammatory index, ΔNLR appears to have some predictive power for the prognosis of patients with NPC.

患者,男,98 岁,4 年前无明显诱因下发现右大腿拇指大小肿物,无压痛,无瘙痒,无皮肤破溃,质韧,活动度差,局部皮温稍高,3个月后肿物长至鸡蛋大小.于2012年2月15日至广西医科大学第一附属医院就诊.

骨肉瘤是最常见的原发性恶性骨肿瘤,其侵袭性高、远处转移早、预后差,在骨原发恶性肿瘤中居首位.全世界每年的发病率为0.001‰～0.003‰,青少年每年的发病率为0.008‰～0.011‰[1].由于新辅助化疗的实施,骨肉瘤患者的5年生存率已经由20世纪70年代的不超过20％上升到目前的80％左右[2].但是,对于一些术后复发或发生多处转移的晚期患者,手术治疗往往难以进行甚至无法进行,只能通过大剂量的化疗进行姑息性治疗.

软骨肉瘤是一种比较常见的骨骼系统恶性肿瘤,占全部原发恶性肿瘤的9.2％,最常发生于骨盆及股骨[1].软骨肉瘤发生于肋骨等扁平骨也偶有报道.一般发生在肋骨的软骨肉瘤常常长到很大时才产生临床症状,而软骨肉瘤对放疗和化疗都不敏感,根治性手术切除是目前治疗软骨肉瘤最好的方法[2].但对于巨大肿瘤切除后如何重建胸壁的稳定,防止连枷胸的出现,缺乏较好的材料,也没有统一的重建方法.国内外关于使用普通骨盆重建钢板重建胸壁的研究尚未见诸于报道.现就胸壁软骨肉瘤患者行肿瘤切除术后应用解剖钢板重建胸腔病例报道如下.

[目的]比较前路病灶清除融合固定术(前融合组)、后路钉棒内固定植骨术(后融合组)与后路钉棒内固定非植骨术(后固定组)治疗单节段胸腰段结核的临床疗效.[方法] 2010年7月～2017年7月,43例单节段胸腰段结核患者纳入本研究,其中前融合组22例,后融合组12例,后固定组9例,给予相应手术治疗.比较三组围手术期、随访和影像资料.[结果]手术耗时依次为前融合组＞后融合组＞后固定组(P＜0.05);三组间术中出血量、术后引流量和平均住院时间差异均无统计学意义(P＞0.05).前融合组术后出现隔下感染1例,肠梗阻1例,窦道形成2例;后融合组术后出现脑脊液漏2例;后固定组无严重术后并发症.所有患者随访24-108个月,平均(35.65±16.47)个月.随访过程中,三组患者均未出现药物中毒反应、结核病灶复发或再次窦道形成等严重事件.三组患者Frankel指数和VAS评分随时间推移显著改善(P＜0.05);相同时间点三组间Frankel指数和VAS评分的差异均无统计学意义(P＞0.05).影像方面,三组术后即刻Cobb角均较术前显著减少(P＜0.05),前融合组的矫正效果显著不及后钉棒两组(P＜0.05);末次随访时,前融合组矫正角度丢失度数大于后钉棒植骨、后固定组(P＜0.05).所有患者均获得椎间骨性融合,融合时间依次前融合组＜后融合组＜后固定组(P＜0.05).[结论]三种术式均能有效治疗单节段胸腰段结核,且无论进行植骨与否均可获得椎间骨性融合效果.

细胞焦亡(pyroptosis)是由多种病理因素(如感染、恶性肿瘤等)触发并由caspase家族蛋白介导的炎症性细胞死亡,其特点是胞膜快速破裂及胞内促炎物质的释放.细胞焦亡的三种路径分别为依赖于caspase-1的经典路径、依赖于caspase-4/5/11非经典路径以及依赖于caspase-3的特殊路径.此外,GSDMD和GSDME也在焦亡过程中发挥了重要作用.细胞焦亡与多种恶性肿瘤关系密切,表现为既可抑制也可促进恶性肿瘤的发生发展.文章就细胞焦亡的路径、细胞焦亡与恶性肿瘤发生发展的关系及其在恶性肿瘤治疗中的研究进展做简要综述.

目的 分析四肢原发性动脉瘤样骨囊肿(aneurysmal bone cyst,ABC)行刮除术后复发的相关危险因素,为其临床治疗和降低复发率提供参考依据.方法 收集2008年1月至2016年6月就诊的83例原发性ABC患者的相关资料,进行至少2年的随访,采用单因素分析、Kaplan-Meier无复发生存曲线分析和多因素Logistic回归分析的统计学方法,对可能的复发危险因素进行分析检验.结果 83病例中,复发15例(18.1％),复发时间为术后2～36个月,中位术后复发时间16个月.单因素分析和Kaplan-Meier法结果显示,年龄、术中高速磨钻的应用和不同充填方式可能影响四肢原发性ABC术后复发(P＜0.05);多因素分析检验结果显示,年龄、术中是否采用高速磨钻为影响原发性ABC术后复发的独立因素(P＜0.05),性别、病变部位及是否合并病理性骨折不影响术后复发(P＞0.05).结论 对四肢原发性ABC患者行刮除术,年龄越小,复发率越高;术中采用高速磨钻辅助打磨可减低术后复发率.

To retrospectively analyze the tumor resection method used in 20 patients with clavicular tumors and evaluate its clinical efficacy. A total of 9 patients with clavicular benign tumors underwent intracapsular resection, and 11 patients with clavicular malignant tumors underwent tumor resection from May 2012 to May 2017. Of the 11 patients, 5 underwent clavicular reconstruction using the plate-cement complex. Surgical efficacy was assessed using the Musculoskeletal Tumor Society, Constant-Murley, and American Shoulder and Elbow Surgeons shoulder outcome scores preoperatively until 12 months postoperatively. The average duration of follow-up care was 33.7 (12–71) months. Of the 20 patients, 3 patients died, 3 survived with tumor recurrence or metastasis, and 14 survived with no tumor recurrence. Among the 5 patients who underwent resection of malignant clavicular tumors and reconstruction, 2 underwent a re-operation because of a loose screw and plate displacement. In the functional assessment of the shoulder joint, patients with benign and malignant clavicular tumors showed significantly higher scores postoperatively compared with preoperative scores. For malignant clavicular tumors, no significant improvement was observed when comparing the non-reconstruction and reconstruction groups. Surgery is an optimal treatment for clavicular tumors. In patients with benign clavicular tumors, simple intracapsular resection can achieve a satisfactory prognosis. Reconstruction of a clavicular defect after resection of a clavicular malignant tumor is not recommended.

患者,女,41岁,无明显诱因下发现左侧颈部肿物近1年,伴有疼痛,自觉左颈部肿物进行性增大,于2018年7月30日就诊广西医科大学第一附属医院. 行CT检查提示鼻咽癌,行活检提示未分化型非角化型癌. 予以 7 野调强放疗( PGTVnx:72 Gy, PGTL-L、R:70 Gy, PTV2:55 Gy,共33次)以及单药顺铂方案(DDP 40 mg/d1,DDP 30 mg/d2 ～4)同步化疗. 患者诉有髂腰部疼痛,胸腰椎MRI检查:T12椎体转移瘤可能性大.骨ECT检查提示:T12椎体转移瘤. 结合患者病情,诊断"鼻咽癌骨转移". 于2018年11月15日行后路T12椎体肿瘤切除+异体骨植骨钛笼融合+钉板系统内固定术,顺利切除 T12椎体占位性病变. 术中出血1600 ml,输同型去白红细胞10 U、血浆800 ml.

目的 探讨电话随访对脊柱结核术后患者服用抗结核药物治疗依从性及疗效影响.方法 选取100例在我科接受手术治疗脊柱结核患者,随机分为观察组(50例)和对照组(50例),对照组进行常规的出院健康指导及门诊随访,观察组在常规出院指导的基础上术后每个月进行电话随访指导.比较两组出院时及出院后12个月治疗依从性,对治疗及医护人员的满意率及对疾病的知晓情况、药物漏服情况和不良反应及结核复发情况.结果 出院后1年时,观察组的用药依从性、疾病知晓率、医护满意率较对照组高(P＜0.05),药物不良反应及结核复发人数较对对照组少(P＜0.05).结论 电话随访有利于促进医患沟通,降低漏服药物的发生率,提高脊柱结核术后患者药物治疗的依从性及疗效.

Study design: Systematic review and meta-analysis. Background: Anchor screw fixation and mini-plate fixation are widely used in unilateral open-door laminoplasty. There is a great controversy over the preferred fixation method. The purpose of this study is to evaluate the clinical outcomes between anchor screw fixation and mini-plate fixation for the treatment of multilevel cervical spondylotic myelopathy (MCSM). Methods: Related studies that compared the clinical effectiveness of anchor screw fixation and mini-plate fixation in cervical laminoplasty for the treatment of MCSM were acquired by a comprehensive search in PubMed, Embase, the Cochrane library, CNKI, VIP, and WANFANG up to March, 2018. Included studies were evaluated according to eligibility criteria. The main end points included: preoperative Japanese Orthopedic Association (JOA) scores, postoperative JOA scores, JOA scores improvement rate, preoperative and postoperative cervical range of motion (ROM), preoperative and postoperative cervical curvature index (CCI), lamina open angle, operation time, blood loss, C5 nerve palsy rate and axial symptoms rate. Results: Papers in English and Chinese were searched for the initial review, but only 12 articles in Chinese were included in this meta-analysis. All of the selected studies were of high quality as indicated by the Newcastle-Ottawa scale (NOS). Among 809 patients, 372 underwent anchor screw fixation and 437 underwent mini-plate fixation. The results of this meta-analysis indicated that no significant difference was found in preoperative JOA score, JOA scores improvement rate, preoperative CCI, preoperative ROM, C5 palsy rate and blood loss. However, compared with mini-plate fixation, anchor screw fixation patients showed higher axial symptoms rate [RR= 1.75, 95% CI (1.31, 2.35), P<.05], lower postoperative JOA scores [SMD= -0.38, 95% CI (-0.62, -0.15), P<.05], lower postoperative CCI [SMD= -0.64, 95% CI (-0.94, -0.33), P<.05], lower postoperative ROM [SMD= -1.11, 95% CI (-2.18, -0.04), P<.05], smaller lamina open angle [SMD= -1.98, 95% CI (-3.71, -0.24), P<.05], shorter operation time [SMD= -0.33, 95% CI (-0.59, -0.07), P<.05]. Conclusions: Compared with anchor screw fixation, mini-plate fixation in cervical laminoplasty appears to achieve better clinical and radiographic outcomes with fewer surgical complications. However, future well-designed, randomized controlled trials are still needed to further confirm our results.

Background: Currently, there are no known reports on the aetiology of local giant cell tumour (GCT) recurrence in the proximal fibula following en bloc resection. We analysed 21 cases of proximal fibular GCT, focusing on the presence of residual bone in the tibiofibular joint, its causes and its impact on postoperative recurrence. Methods: We retrospectively analysed 21 cases with proximal fibular GCT occurring between 2000 and 2017. Results: There were 14 males and 7 females. The average patient age was 25.0 years. Seventeen patients were diagnosed and treated at our facility, while 4 were referred after local recurrence. Six patients presented with residual bone fragments in the tibiofibular joint during their first month of follow-up. Patients with residual bone fragments had a higher local recurrence rate (83.3%) than those without (0%, p = 0.0003). Upon further analysis, patients with a preoperative Campanacci grade III tumour (p = 0.0055) and pathological fractures (p = 0.0109) were at a higher risk of exhibiting postoperative residual bone fragments. Conclusions: The presence of residual bone fragments in the tibiofibular joint was the main cause of postoperative local recurrence. The presence of residual bone fragments may be related to the preoperative Campanacci grade and pathological fractures. Therefore, close attention should be paid to postoperative follow-up examinations, and if recurrence is suspected, surgical resection should be planned.

Objective: To explore the clinical characteristics, imaging feature, surgical outcomes, and prognosis of recurrent aneurysmal bone cysts (RABC) of the extremities. Methods: Between January 2008 and January 2016, 29 patients histopathologically diagnosed with RABC were treated at our hospital. These patients included 15 males and 14 females. The mean age at the time of diagnosis was 17.4 years(range 4-42 years). The most common site of the RABC was the proximal tibia (12 cases), followed by the distal femur (11 cases), and 3 cases each with involvement of the proximal humerus and the proximal femur. Recurrence was most commonly ob-served within 24 months following the initial treatment. Intralesional re-curettage was performed in 24 patients and en bloc resection of the tumor and reconstruction in 5 patients. The medial tibial stress syndrome (MTSS) score was used to evaluate postoperative func-tion of the affected limb, and the comprehensive clinical efficacy was evaluated on the basis of the Mankin criteria. Results: The mean follow-up duration was 64 months (range 24-90 months). Re-recurrence occurred in 1 patient with a total re-recurrence rate of 3.4%. The postoperative MTSS score was 26-30 points (mean 29.1 points) in the intralesional re-curettage group and 21-27 points (mean 23.0 points) in the tumor resection group. Based on the Mankin criteria, excellent and good clinical outcomes were observed in 95.8% of patients in the intralesional and 60% of the patients in the tumor resection and reconstruction groups. Conclusions: Regular follow-up is essential for the early diagnosis of RABC. The re-recurrence rate following intralesional re-curettage was within an acceptable range, and postoperative limb function was satisfactory; therefore, intralesional re-curettage is the treatment of choice for RABC in-volving the extremities. Tumor resection can be performed in patients with severe articular surface destruction and repeated recur-rence, although long-term complications may occur.