Ould Slimane M, Foulongne E, Derrey S, Fréger P, Proust F
Service de neurochirurgie, CHU de Rouen, 1, avenue de Germont, 76031 Rouen cedex, France.
Neurochirurgie. 2009 Dec;55(6):595-9. doi: 10.1016/j.neuchi.2009.05.001. Epub 2009 Jul 4.
Polyostotic fibrous dysplasia of the thoracic spine is extremely rare and considered a benign disease. We report the case of a 46-year-old woman admitted to the emergency department for subacute paraplegia. The spinal X-ray showed a spontaneous fracture at the T4-T5 level. The CT scan revealed a tumor infiltration of the vertebral body responsible for lysis. Spinal MRI confirmed the neoplasia also located in the epidural space with spinal cord compression. The patient underwent an emergency laminectomy associated with transpedicular screw fixation between the T2 and T6 levels. At 2 months, she had evolved to a normal gait. In the second session, a transthoracic approach was used for a bone-graft-assisted fusion procedure to achieve long-term stabilization. At 4 years, the bone fusion was excellent and the patient was able to resume socioprofessional activities. The diagnosis of fibrous dysplasia is usually made histologically on surgical biopsy but MRI and CT scan sometimes provide a preliminary indication. Although a consensus for management of this disease has not been achieved, the authors recommend radical removal of all involved tissues accompanied by internal fixation and bone-graft-assisted fusion.
胸椎多骨型纤维结构不良极为罕见，被视为一种良性疾病。我们报告了一例46岁女性因亚急性截瘫入住急诊科的病例。脊柱X线显示T4 - T5水平有自发性骨折。CT扫描显示椎体肿瘤浸润导致骨质溶解。脊柱MRI证实肿瘤也位于硬膜外间隙并压迫脊髓。患者接受了急诊椎板切除术，并在T2和T6水平进行了经椎弓根螺钉固定。2个月时，她的步态已恢复正常。在第二次手术中，采用经胸入路进行骨移植辅助融合手术以实现长期稳定。4年后，骨融合情况良好，患者能够恢复社会职业活动。纤维结构不良的诊断通常通过手术活检进行组织学诊断，但MRI和CT扫描有时也能提供初步线索。尽管对于该疾病的治疗尚未达成共识，但作者建议彻底切除所有受累组织，并辅以内固定和骨移植辅助融合。
