骨肿瘤诊断及治疗进展课件

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2021/5/7,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2021/5/7,*,骨肿瘤诊断及治疗进展,2021/5/7,1,骨肿瘤诊断及治疗进展2021/5/71,Chinese Musculoskeletal Tumor Society,1985,2009,2021/5/7,2,Chinese Musculoskeletal Tumor,International Workshop of Limb Salvage,To exchange the experiences in the design and application of custom implant and reconstructive techniques in patients with massive skeletal defect after tumor resection,2021/5/7,3,International Workshop of Limb,ISOLS,Diagnosis,Neo-adjuvant & adjuvant Rx,Implant/graft selection & fixation,Soft tissue deficiency,F,unctional reconstruction,Longevity of reconstruction,Adjustment to growing limbs,2021/5/7,4,ISOLS Diagnosis2021/5/74,Radiology,X,线检查在肿瘤的早期，尤其是对肿瘤髓腔内累及范围并不敏感。,CT,和,X,线对肿瘤组织的矿化检查效果比较好，对诊断骨肿瘤有较好的价值。,MRI,对软组织肿瘤及肿瘤髓腔内蔓延的诊断有价值。,2021/5/7,5,Radiology2021/5/75,Radiology,良、恶性病变在,T1,、,T2,像上的表现没有特殊性。,T1,像结果和肿瘤的实际大小比较相符。鉴别肿瘤和周围的水肿，,T1,增强抑脂像要比,T2,像的结果更准确。,T1,增强抑脂像能够增加肿瘤和周围组织之间的对比。,PET,检查对肿瘤的鉴别诊断没有太大帮助。,MRI,检查可以确定肿瘤血供丰富的组织，,PET,检查可以确定肿瘤代谢活跃的组织。,2021/5/7,6,Radiology良、恶性病变在T1、T2像上的表现没有特殊,Biopsy,闭合活检,创伤小、软组织污染较轻，但对于硬化的成骨组织难以取出。对于脊柱、骨盆等复杂的解剖部位，芯针活检有其特殊的优点。,穿刺活检的缺点是得到的组织标本量少，可能导致取材错误。穿刺活检的准确率约为,85%,。取材错误的原因是任何病灶均具有异质性。取得的标本无法代表整个病灶。,2021/5/7,7,Biopsy 闭合活检2021/5/77,Biopsy,切开活检,切开活检获取的组织标本量大，切开活检的诊断准确率达,96%,。,切开活检的缺点是手术时间较长，血肿、病理骨折等并发症较高。,切开活检操作不当时，不正确的切口位置、切口方向、以及过于广泛的软组织沾染会给正式的肿瘤切除术带来很大困难。,2021/5/7,8,Biopsy 切开活检2021/5/78,Training on Surgical Skills,Concept,-surgical principles for all kinds of musculoskeletal tumors,Surgical Staging and resection margin,Surgical Skills-,-study, training and experience.,Evaluation and,review every case,Functional evaluation,Oncology results,2021/5/7,9,Training on Surgical SkillsCon,Training on Surgical Skills,Approach,exposure,Resection margin,Control bleeding measure,Trans-articular excision,Extra-articular excision,Soft tissue coverage,2021/5/7,10,Training on Surgical SkillsApp,9,、 人的价值，在招收诱惑的一瞬间被决定。,2024/8/28,2024/8/28,Wednesday, August 28, 2024,10,、低头要有勇气，抬头要有低气。,2024/8/28,2024/8/28,2024/8/28,8/28/2024 9:44:35 AM,11,、人总是珍惜为得到。,2024/8/28,2024/8/28,2024/8/28,Aug-24,28-Aug-24,12,、人乱于心，不宽余请。,2024/8/28,2024/8/28,2024/8/28,Wednesday, August 28, 2024,13,、生气是拿别人做错的事来惩罚自己。,2024/8/28,2024/8/28,2024/8/28,2024/8/28,8/28/2024,14,、抱最大的希望，作最大的努力。,28 八月 2024,2024/8/28,2024/8/28,2024/8/28,15,、一个人炫耀什么，说明他内心缺少什么。,八月 24,2024/8/28,2024/8/28,2024/8/28,8/28/2024,16,、业余生活要有意义，不要越轨。,2024/8/28,2024/8/28,28 August 2024,17,、一个人即使已登上顶峰，也仍要自强不息。,2024/8/28,2024/8/28,2024/8/28,2024/8/28,2021/5/7,11,9、 人的价值，在招收诱惑的一瞬间被决定。2023/9/42,Training on Surgical Skills,Allograft reconstruction,Autograft reconstruction,Recycled bone implantation,Prosthesis,2021/5/7,12,Training on Surgical SkillsAll,Treatment of patients with primary malignant bone tumor in People,s Hospital,恶性骨肿瘤,2000 2001 2002 2003 2004 2005 2006 2007 2008,合计,骨肉瘤,35 39 41 33 43 41 45 58 62,397,近皮质骨肉瘤,1 2 1 1 2 2 1 2 2 14,软骨肉瘤,11 15 17 13 15 21 29 20 28,169,尤文肉瘤,5 7 8 7 13 13 17 11 17,98,淋巴瘤,3 5 6 8 6 9 6 8 0 60,骨髓瘤,7 7 9 10 11 9 14 21 14,100,血管内皮瘤,0 1 1 1 2 0 0 3 1 9,骨纤维肉瘤,1 2 3 1 2 2 0 2 3 16,骨恶纤组,3 4 4 3 7 6 8 5 7 47,脊索瘤,8 9 11 3 12 14 12 17 16,102,骨脂肪肉瘤,0 1 1 2 2 3 2 1 0 12,骨恶性神经鞘,0 0 1 1 3 3 3 4 5 20,恶性巨细胞瘤,0 1 1 0 2 3 1 6 4 18,恶性骨母,0 0 1 0 0 1 0 1 3 6,骨血管肉瘤,0 1 1 0 0 0 1 1 0 4,造釉细胞瘤,1 0 0 0 0 0 2 0 0 3,骨平滑肌肉瘤,0 0 1 1 0 0 1 0 0 3,恶性畸胎瘤,1 2 3,共计,75 94 107 84 120 125 138 160 162 1148,2021/5/7,13,Treatment of patients with pri,Treatment of patients with benign bone tumor in People,s Hospital,良性骨肿瘤,2000 2001 2002 2003 2004 2005 2006 2007 2008,合计,骨瘤,0 0 0 0 2 0 1 1 1 5,骨样骨瘤,1 2 2 7 6 5 4 4 3 34,骨母细胞瘤,2 3 3 2 2 1 2 2 1 18,软骨瘤,2 2 3 2 2 5 6 5 5 32,骨软骨瘤,9 10 13 8 12 8 9 8 14,91,软粘纤,1 0 1 0 0 0 2 1 0 5,骨巨细胞瘤,23 27 29 13 26 25 27 41 40,251,骨血管瘤,3 3 4 3 5 10 5 5 6 44,骨脂肪瘤,0 0 0 2 1 0 0 1 1 5,骨良纤组,1 1 2 1 2 5 1 1 5 19,软骨母细胞瘤,3 5 4 2 1 6 6 3 4 34,骨化性纤维瘤,3 5 5 2 1 1 1 3 2 23,非骨化性纤维瘤,1 2 2 1 1 2 4 3 2 18,滑膜软骨瘤,1 2 1 0 1 0 1 2 3 11,骨平滑肌瘤,1 1,共计,591,2021/5/7,14,Treatment of patients with ben,Treatment of patients with tumor-like disease in People,s Hospital,骨瘤样病变,2000 2001 2002 2003 2004 2005 2006 2007 2008,合计,骨囊肿,6 7 7 6 8 5 6 6 7,56,动脉瘤样骨囊肿,3 5 5 2 3 6 4 4 2 34,嗜酸性肉芽肿,1 2 3 3 4 7 4 6 4 34,纤维结构不良,7 8 9 9 7 13 11 11 10,86,骨化性肌炎,1 0 0 2 1 1 4 9,错构瘤,1 0 1 2 2 0 0 6,甲旁亢,1 1 0 0 1 2 0 1 0 6,共计,232,2021/5/7,15,Treatment of patients with tum,2000-2008,年恶性骨肿瘤部位分布（,北大人民,）,类别,肩胛骨,胸骨,脊柱,锁骨,肋骨,桡骨,尺骨,腕骨,骨盆,骶骨,腓骨,肘,足,总计,%,肱骨,股骨,胫骨,骨肉瘤,5,4,3,1,45,4,21,6,218,112,18,437,37,近皮质骨肉瘤,12,2,14,软骨肉瘤,13,16,5,7,76,14,29,11,171,14.5,尤文氏肉瘤,3,1,11,1,10,1,35,5,15,7,3,3,3,98,8.3,淋巴瘤,5,20,1,4,1,14,5,8,2,60,骨髓瘤,1,61,1,1,11,12,9,3,1,100,恶性血管内皮瘤,1,2,1,2,3,9,骨纤维肉瘤,2,3,4,7,16,骨的,MFH,1,6,2,2,9,3,37,12,72,脊索瘤,9,1,98,108,骨平滑肌肉瘤,1,1,2,骨脂肪肉瘤,2,2,3,5,12,骨的血管肉瘤,1,1,2,4,骨恶性神经鞘瘤,2,7,6,4,19,血管外皮瘤,1,1,2,恶性骨母细胞瘤,2,1,3,恶性巨细胞瘤,2,1,1,2,5,1,3,1,16,恶性畸胎瘤,2,9,11,造釉细胞瘤,2,2,转移瘤,13,8,309,6,3,33,2,2,106,80,85,18,1,1,667,总计,1848,2021/5/7,16,2000-2008年恶性骨肿瘤部位分布（北大人民）类别肩胛骨,2000-2008,年,良性骨肿瘤,部位分布,类别,肩胛骨,上臂,脊柱,锁骨,肋骨,肱骨,桡骨,尺骨,手,骨盆,骶尾,膝关节,股骨,髌骨,胫骨,腓骨,肘,足,多发,总计,骨瘤,1,1,1,4,骨平滑肌瘤,1,1,骨样骨瘤,2,1,2,1,1,1,9,10,2,1,2,1,33,良性骨母细胞瘤,9,2,4,1,1,1,18,软骨瘤,1,3,1,9,10,2,1,5,32,骨软骨瘤,8,4,1,1,11,5,2,5,2,17,1,24,11,1,3,5,101,软骨粘液样纤维瘤,2,1,1,1,5,骨巨细胞瘤,39,2,15,11,1,1,28,51,75,1,47,5,2,278,骨血管瘤*,38,1,1,1,3,44,骨脂肪瘤*,2,1,1,4,骨良性纤维组织细胞瘤,2,1,1,7,5,1,1,18,软骨母细胞瘤,4,4,2,10,11,1,33,骨化性纤维瘤,2,2,1,1,1,1,5,12,1,26,滑膜软骨瘤,1,5,3,1,1,11,总计,590,2021/5/7,17,2000-2008年良性骨肿瘤部位分布类别肩胛骨上臂脊柱锁骨,2000-2008,年骨瘤样病变部位分布,类别,肩胛骨,大腿,小腿,下颌骨,脊柱,锁骨,肋骨,肱骨,桡骨,尺骨,骨盆,骶骨,腹股沟,股骨,髌骨,胫骨,腓骨,肘,足,臀部,总计,骨囊肿,3,15,1,4,3,24,1,1,1,3,56,动脉瘤样骨囊肿,4,7,1,7,1,3,3,6,3,2,37,非骨化性纤维瘤,8,9,17,嗜酸性肉芽肿,5,1,7,1,2,5,1,6,4,1,34,纤维结构不良,3,4,2,4,2,13,1,38,17,1,86,骨化性肌炎,3,3,1,7,错构瘤,1,2,1,6,甲状旁腺机能亢进性,棕色素瘤,1,1,1,2,5,总计,9,3,3,1,20,2,5,25,5,3,25,9,2,83,2,34,2,1,6,1,243,2021/5/7,18,2000-2008年骨瘤样病变部位分布类别肩胛骨下颌骨脊,类别,大腿,背部,颈部,肩,前臂,上臂,手,胸腹壁,髂窝,国窝,小腿,腹股沟,脊柱,骶尾,膝,尺骨,肱骨,股骨,骨盆,肘,足,臀部,腹膜后,总计,恶性,纤维肉瘤,7,1,1,2,1,1,1,3,8,1,2,3,3,34,脂肪肉瘤,25,1,1,1,3,2,2,6,1,1,3,46,恶性神经鞘瘤,9,2,2,1,1,1,1,1,7,1,1,1,1,1,1,31,滑膜肉瘤,15,1,3,2,2,1,3,7,2,3,3,1,1,5,9,4,8,1,71,上皮样肉瘤,1,1,1,1,2,3,1,1,11,平滑肌肉瘤,2,2,腺泡状软组织肉瘤,3,2,1,3,9,横纹肌肉瘤,3,1,1,2,1,1,2,1,12,恶性黑色素瘤,1,1,16,18,透明细胞肉瘤,1,1,1,1,1,5,粒细胞肉瘤,1,1,梭形细胞肉瘤,1,1,1,3,MFH,25,5,2,5,6,3,3,13,4,1,2,1,3,1,74,总计,91,10,4,10,9,12,4,10,8,6,47,11,7,4,4,1,2,5,14,10,31,16,1,317,2000-2008,年软组织恶性肿瘤部位分布,2021/5/7,19,类别大腿前臂上臂手胸腹壁国窝小腿脊柱骶尾肱骨,.,大腿,背部,颈部,肩,前臂,上臂,手,胸腹壁,髂窝,腘窝,小腿,腹股沟,脊椎,骶尾,膝,骨盆,肘,足,臀部,腹膜后,总计,良性,肌间粘液瘤,1,1,2,良性间叶瘤,2,2,结节性筋膜炎,1,1,2,节细胞神经瘤,1,1,尾肠囊肿,2,2,腱鞘囊肿,3,1,1,8,7,2,4,7,11,44,脂肪瘤,(,骨外,),30,17,10,13,5,12,2,1,1,1,10,2,3,4,8,119,血管瘤,(,骨外,),8,2,1,7,6,9,5,12,1,1,5,4,3,64,良性纤维组织细胞瘤,1,1,1,1,2,3,9,神经鞘瘤,2,1,2,1,1,3,2,3,20,17,1,2,5,3,1,64,纤维瘤病,6,6,2,12,5,6,5,5,5,5,1,1,2,3,3,13,1,81,腱鞘巨细胞瘤,15,7,1,9,32,韧带样纤维瘤,11,2,1,3,1,1,3,6,2,1,8,5,1,6,51,腘窝囊肿,31,31,滑膜囊肿,1,5,1,7,软组织神经束衣瘤,1,1,色素绒毛结节性滑膜炎,2,7,1,2,11,滑膜炎,1,1,1,1,1,3,2,2,12,神经纤维瘤,3,4,3,2,4,7,2,6,5,1,24,38,1,2,4,1,2,6,115,畸胎瘤,2,2,2,1,1,1,14,3,2,2,3,33,总计,55,29,19,34,26,37,49,15,38,13,45,3,48,74,33,19,36,38,38,8,683,2000-2008,年软组织良性肿瘤部位分布,2021/5/7,20,.大腿前臂上臂手胸腹壁腘窝小腿脊椎骶尾骨盆肘足臀,2000-2008,年人民医院骨转移癌病例共,663,人,部位,2000-2002,2003,2004,2005,2006,2007,2008,合计,尺骨,1,1,2,骶尾,12,14,10,5,12,16,11,80,脊柱,77,27,41,31,43,45,45,309,颈椎,6,2,2,2,1,5,4,22,胸椎,38,7,22,16,26,16,15,140,腰椎,26,15,14,12,9,15,21,112,颈胸段,2,1,2,3,8,胸腰段,5,3,3,1,6,7,2,27,股骨,26,7,7,9,9,12,13,83,腓骨,1,1,肱骨,9,1,3,6,7,5,31,骨盆,31,11,5,13,12,13,19,104,肩胛骨,3,1,1,1,2,3,2,13,胫骨,9,2,1,5,1,18,胸腹壁,3,2,1,1,7,腕骨,1,1,桡骨,1,1,2,肋骨,1,1,1,3,锁骨,1,2,1,1,2,7,足,1,1,总计,173,62,67,68,86,105,100,663,2021/5/7,21,2000-2008年人民医院骨转移癌病例共663人部位200,化疗效果评估方法,临床评估：,主要是依据病人主观症状减轻、疼痛缓解，临床检查肿瘤体积缩小，肿瘤部位皮温减低，邻近关节活动度改善。,45cm,37cm,2021/5/7,22,化疗效果评估方法45cm37cm2021/5/722,肿瘤,体积,变化,椭球模型：,V/6,长径,横径,矢径,V,变（,V2-V1,）,/ V1,判别标准：,V,变,5%,，肿瘤体积增大,V,变,-5%,，肿瘤体积缩小,V,变绝对值,5%,，体积不变,化疗前体积,化疗后体积,2021/5/7,23,肿瘤体积变化椭球模型：V/6长径横径矢径化疗前体积,化疗效果评估方法,化验室检查， 血中,AKP,、,LDH,下降。,同位素扫描，观察化疗前后放射性核素的浓集程度和范围。,术前化疗疗效最客观的评估方法是肿瘤坏死率的检测。,2021/5/7,24,化疗效果评估方法化验室检查， 血中AKP、LDH下降。202,单因素卡方检验,项目,坏死率好（,III-IV,）,坏死率差（,I-II,）,卡方,P,值,体积变化,减小,17,（,56.7%,）,5,（,11.9%,）,18.289,0.001,不变,11,（,36.7%,）,23,（,54.8%,）,增大,2,（,6.7%,）,14,（,33.3%,）,边界变化,变清晰,18,（,60%,）,14,（,33.3%,）,5.040,0.025,不变或模糊,12,（,40%,）,28,（,66.7%,）,2021/5/7,25,单因素卡方检验项目坏死率好（III-IV）坏死率差（I-II,多因素,logistic,回归,项目,OR,值,95%CI,Wald,值,P,值,钙化,钙化增加,1,0.9-9.3,3.248,0.072,不变或减少,2.9,体积变化,体积减小,0.035,0.005-0.237,11.735,0.001,体积不变,0.318,0.057-1.789,1.689,0.194,体积增大,1,2021/5/7,26,多因素logistic回归项目OR值95%CIWald值P值,kaplan-meier,生存分析,项目,数量,%of EFS,P,值,化疗前肿瘤体积,250ml,35,88.6%,0.030,250ml,37,54.1%,坏死率,I,级,4,50%,0.002,II,级,38,68.4%,III,级,23,82.6%,IV,级,7,71.4%,2021/5/7,27,kaplan-meier生存分析项目数量%of EFSP值,Limb salvage surgery,2021/5/7,28,Limb salvage surgery2021/5/728,Segmental Reconstruction,Recycled tumor bone reimplantation,Autograft/allograft,Prosthetic implant,Bone transport/lengthening:,“,Distraction Osteosynthesis”,2021/5/7,29,Segmental Reconstruction Recyc,肿瘤型人工关节,2021/5/7,30,肿瘤型人工关节2021/5/730,In 1940,Austin T. Moore designed with Howmedica a Proximal Femur,2021/5/7,31,In 1940 Austin T. Moore design,70,年代早期,大剂量化疗成功实施,恶性骨肿瘤保肢治疗得到发展,1973,年, Kenneth Francis,为一股骨远端,GCT,患者进行了铰链型膝关节置换。,2021/5/7,32,70年代早期大剂量化疗成功实施2021/5/732,The Evolution of Endoprosthetic Design,Custom,Modular Cemented,Modular Press fit/Ingrowth,Expandable,2021/5/7,33,The Evolution of Endoprostheti,水泥型固定,早期假体可靠固定,早期功能锻练,固定物与髓腔的几何学匹配,减少髓腔内出血,2021/5/7,34,水泥型固定早期假体可靠固定2021/5/734,非水泥型固定,远期结果优于水泥型假体,增加血肿发生率,不能早期下地负重,压配柄,采用钛浆喷涂技术,骨,-,生物技术,钛金属表面磷灰石,2021/5/7,35,非水泥型固定远期结果优于水泥型假体2021/5/735,Makisu,Grafting Technique,TE for Implant or Graft Fixation,2021/5/7,36,Makisu Grafting Technique TE f,B,B,A,A,Invert the allograft,Ream out 5 cm + of medulla,Impact to trombone graft,Bypass the junction by 2 diameters,Cut graft to the desired length,Cement a long stem prosthesis,Telescope,Allograft Revision - Reconstruction,2021/5/7,37,BBAAInvert the allograftBypass,Endoprosthetic replacement for Osteosarcoma around the knee,104 osteosarcoma patients were treated with the distal femoral and proximal tibial endoprosthetic replacement between July 1998 and July 2005.,The mean age was 26.0 years (7 to 65).,The distal femur in 65 and the proximal tibia in 39 patients.,The prosthetic stem was cemented in all patients,W. Guo, et al. J Bone Joint Surg 2008,；,90-B,：,1084,2021/5/7,38,Endoprosthetic replacement for,Mean functional Musculoskeletal Tumor Society score,Measure Entire sample Distal femur Proximal tibia,Pain 4.7 (0.6) 4.7 (0.6) 4.7 (0.5),Function 3.7 (1.0) 3.8 (1.0) 3.6 (1.1),Supports 4.2 (1.4) 4.3 (1.2) 3.9 (1.6),Walking 3.5 (1.0) 3.5 (1.1) 3.4 (1.0),Gait 3.3 (1.0) 3.4 (1.1) 3.3 (1.1),Acceptance 3.6 (1.1) 3.6 (1.2) 3.6 (1.1),Total score (%),76.3,(17.8),77.0,(17.7),75.1,(18.2),2021/5/7,39,Mean functional Musculoskeleta,The estimated five-year survival for the prosthesis was 70.5% and for the limb was 90%.,2021/5/7,40,The estimated five-year surviv,The survival rate of the proximal tibia was significantly lower than that of the distal femur (p = 0.0276).,2021/5/7,41,The survival rate of the proxi,The rate was significantly lower for the tibial prosthesis with resection length longer than 14 cm (p = 0.004).,2021/5/7,42,The rate was significantly low,Sacral tumor resection,手术入路,彻底切除,控制出血,降低复发,2021/5/7,43,Sacral tumor resection20,骶骨,1998-2002,2003,2004,2005,2006,2007,2008,合计,脊索瘤,33,3,12,14,7,16,13,98,骨巨细胞瘤,14,2,8,6,8,6,16,60,恶性巨细胞瘤,1,1,2,4,尤文肉瘤,/PNET,2,1,3,1,1,1,3,12,转移癌,12,14,10,7,12,16,10,81,淋巴瘤,1,1,1,2,5,骨肉瘤,2,2,2,2,8,软骨肉瘤,2,2,1,1,1,3,3,13,恶性神经鞘瘤,1,1,1,1,2,6,神经鞘瘤,5,5,1,4,5,20,神经纤维瘤,8,2,7,5,3,3,7,35,骨髓瘤,3,2,1,1,3,1,11,骨母细胞瘤,3,1,4,恶纤组,2,1,1,4,纤维结构不良,1,1,动脉瘤样骨囊肿,2,1,3,畸胎瘤,1,1,3,3,4,13,总计,92,26,48,39,40,61,65,375,2021/5/7,44,骶骨1998-20022003200420052006200,Primary malignant tumor involving up sacrum,Combining of anterior and posterior approach (en bloc resection),2021/5/7,45,Primary malignant tumor involv,Pelvic tumor resection,整块切除,控制出血,功能重建,2021/5/7,46,Pelvic tumor resection202,骨盆肿瘤种类,1998-2002,2003,2004,2005,2006,2007,2008,合计,骨肉瘤,9,3,3,2,8,25,骨巨细胞瘤,14,2,2,1,1,7,3,30,恶性巨细胞瘤,2,2,纤维结构不良,1,1,3,2,2,3,12,尤文肉瘤,/PNET,13,1,4,1,6,6,2,33,淋巴瘤,4,3,1,2,1,1,2,14,骨髓瘤,2,1,3,2,3,3,1,15,软骨母细胞瘤,1,2,1,4,软骨肉瘤,32,6,7,6,11,7,10,79,恶性外周神经鞘瘤,1,2,2,2,3,10,硬纤维瘤,1,2,3,1,6,动脉瘤样骨囊肿,2,1,3,恶纤组,5,1,3,2,1,3,15,骨软骨瘤恶变,1,2,1,4,转移癌,31,11,6,11,12,13,17,101,总计,117,25,33,32,44,48,52,352,2021/5/7,47,骨盆肿瘤种类1998-2002200320042005200,Spinal tumor resection,彻底切除,手术入路,控制出血,功能重建,2021/5/7,48,Spinal tumor r,脊柱,2000-2002,2003,2004,2005,2006,2007,2008,合计,转移癌,77,27,41,31,43,45,45,309,脊索瘤,1,2,1,1,5,滑膜肉瘤转移,1,1,1,3,尤文肉瘤,1,2,1,6,恶纤组脊柱转移,3,1,4,骨肉瘤,1,2,2,5,骨髓瘤,10,5,8,5,6,14,9,57,恶性外周神经鞘瘤,2,1,2,1,6,神经鞘瘤,4,4,2,1,3,7,1,22,神经纤维瘤,17,3,5,2,1,28,淋巴瘤,3,3,1,3,1,5,3,19,骨母细胞瘤,4,1,2,2,9,侵袭性骨母细胞瘤,2,2,软骨肉瘤,4,1,5,5,1,1,17,血管瘤,11,3,4,9,5,3,4,39,骨巨细胞瘤,12,3,5,6,13,4,43,恶性巨细胞瘤,1,1,2,PNET,2,1,1,4,动脉瘤样骨囊肿,4,1,2,7,硬纤维瘤,1,1,2,粒细胞肉瘤,1,1,2,髓细胞肉瘤,3,3,血管内皮瘤,1,1,1,3,总计,152,40,69,66,83,98,76,597,2021/5/7,49,脊柱2000-20022003200420052006200,一期后路全脊椎切除,Tomita,于,1997,年首先报道：,后路单一切口,有效降低局部复发率,手术难度大、耗时长、,风险高,2021/5/7,50,一期后路全脊椎切除2021/5/750,全脊椎切除,(Boriani),2021/5/7,51,全脊椎切除 (Boriani) 2021/5/751,