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儿童坐骨骨巨细胞瘤继发动脉瘤样骨囊肿1例

2019-05-28 唐海军 肖增明 刘云 临床骨科杂志

患儿,女,9岁,因“左臀部疼痛1年余,加重1个月”于2015年12月8日步行入院。患儿1年前出现左侧臀部疼痛,夜间显著,当时未予重视。近1个月来疼痛明显加重,至当地医院就诊,行肿物穿刺活检,病理提示:骨巨细胞瘤。入院查体:正常步态,双下肢等长。左坐骨支压痛,可及深部肿物,质硬、压痛,无活动。CT显示:左侧坐骨膨胀性囊状改变,骨皮质变薄并见骨缺损(见图1)。MRI平扫加增强提示:左侧坐骨斑片状异常信

临床资料

患儿,女,9岁,因“左臀部疼痛1年余,加重1个月”于2015年12月8日步行入院。患儿1年前出现左侧臀部疼痛,夜间显著,当时未予重视。近1个月来疼痛明显加重,至当地医院就诊,行肿物穿刺活检,病理提示:骨巨细胞瘤。入院查体:正常步态,双下肢等长。左坐骨支压痛,可及深部肿物,质硬、压痛,无活动。CT显示:左侧坐骨膨胀性囊状改变,骨皮质变薄并见骨缺损(见图1)。MRI平扫加增强提示:左侧坐骨斑片状异常信号,增强扫描病灶明显强化,未见液液平面,考虑左侧坐骨动脉瘤样骨囊肿。结合患儿发病年龄、影像学检查及穿刺结果,诊断:左侧坐骨骨巨细胞瘤继发动脉瘤样骨囊肿。完善术前检查并排除手术禁忌证,于2015年12月12日行左侧坐骨肿物刮除联合自体骨、异体骨植入术。



讨论

手术方式:全身麻醉。以左股骨大转子为中心在臀部后外侧做弧形切口,切开皮肤、深筋膜、阔筋膜张肌的筋膜,切断部分臀大肌,向后侧牵开,显露关节囊的后方。探查周围血管及坐骨神经,松解坐骨神经周围组织。牵开保护臀中肌,在股骨近端肌肉止点处,电刀切断短外旋肌群(梨状肌、上下孖肌、闭孔内肌),剥离显露髋臼后缘及关节囊的后方。见左坐骨区深部10CM×8CM×8CM椭圆形肿物,左坐骨支、部分髋臼后缘被浸蚀、破坏、吸收。在坐骨肿物外壁切开3CM×3CM骨窗,立即有大量血性积液涌出,并伴有内壁凶猛的广泛活动出血,遂使用不同大小的刮匙迅速刮除积血及腔内混着胶冻样多房性肿瘤组织,大块纱条填压止血。逐步显露内壁出血点,逐一电凝止血。予腔内灌注无水乙醇、碘酒浸泡,电刀高温灼烧灭活内壁活性组织。取左侧中段腓骨长约10CM,裁剪成2~3CM小段,取左侧髂骨剪成细粒,混合一包异体骨一起填塞压入肿瘤腔。放置引流管并逐层缝合。术中出血约300ml,术中输血1.5U,术后血压稳定。

术后病理:低倍镜下见骨巨细胞瘤继发动脉瘤样骨囊肿形成,囊肿内可见大量红细胞,高倍镜下见病变以单核间质细胞和散在其中的多核巨细胞为主。

免疫组化:p63阳性单核细胞>60%,多核细胞CD68、Ki-67:15%~20%。病理结论:符合骨巨细胞瘤继发动脉瘤样骨囊肿。术后随访31个月,复查CT提示植入骨块生长良好,相互融合,未见复发和转移征象。

原始出处:

唐海军,肖增明,刘云.儿童坐骨骨巨细胞瘤继发动脉瘤样骨囊肿1例[J].临床骨科杂志,2019,22(02):256.

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    2020-03-16 feifers
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    2019-05-30 wwzzly

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