股骨远端巨细胞瘤伴病理性骨折1例

Shubham Prakashrao Vaidya, Sushil H Mankar, R. Sakhare, Satyajeet Deshpande, Ambar Daware
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引用次数: 0

摘要

骨巨细胞瘤(GCTB)是一种多为良性的骨肿瘤,偶尔也可发展为恶性肿瘤,通常发生在慢性病例中。它是一种常见的良性和侵袭性骨肿瘤,影响20-45岁的患者。本文报告一例股骨远端巨细胞瘤(GCT)伴术中并发症。37岁女性,左膝疼痛肿胀1个月。在临床检查中,患者在膝关节前外侧有压痛和肿胀,从股骨远端延伸到膝关节外侧。肿胀清晰、光滑、坚硬、均匀,尺寸约为12cm × 8cm。膝关节活动受限。受影响的膝关节x光片显示,在其外侧,股骨远端出现软组织肿块。MRI显示软组织肿块伴皮质破裂。在这个病例中,我们计划使用夹心技术进行植骨刮除和骨水泥粘合,但在处理肢体时,内侧皮质发生断裂,然后在第二次固定中使用股骨远端外侧锁定钢板和水泥固定,因为在初始手术中股骨远端钢板不可用。手术后,送标本进行组织病理学检查,结果为高级别巨细胞瘤。由于复发率高,肿瘤应完全切除。最后,重建膝关节功能以减少损失。另一种选择是将受影响的关节切除并进行关节融合术,但这会导致关节僵硬;另一种选择是在定制假体的帮助下对受影响的关节进行关节成形术,但这种手术过于昂贵,因此我们选择了骨水泥与植骨(三明治技术)结合钢板的扩展刮除。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Giant cell tumor of distal femur with pathological fracture: A case report
Giant cell tumor of bone (GCTB) is a mostly benign bone tumor which can occasionally progress to malignancy, usually in chronic cases. It is a common benign and aggressive bone tumor that affects patients aged 20-45 years. A case of giant cell tumor (GCT) of the distal femur is reported here with an intraoperative complication. A 37-year female presented with a 1-month history of painful swelling over her left knee. On clinical examination, the patient had tenderness and swelling on the anterolateral aspect of the knee extending from the distal part of the femur towards the lateral aspect of the knee. Swelling was well-defined, smooth, firm, and uniform in consistency with dimensions of about 12cm x 8 cm. Knee movement was restricted. An X-ray of the affected knee revealed a soft tissue mass arising from the distal femur on its lateral aspect. MRI revealed a soft tissue mass with the cortical breach. In this case, we planned for curettage with bone grafting and bone cementing using a sandwich technique, but while handling the limb, an medial cortical breach occurred, which was then fixed with the help of a distal femur lateral locking plate and cement in the second setting due to unavailability of distal femur plates during the initial surgery. Following surgery, a sample was sent for histopathology, which s/o high-grade giant cell tumor. Because of the high risk of recurrence, the tumor should be completely removed. Finally, the Knee function recreated to minimize the loss. Another options were enblock excision with arthrodesis of the affected joint but that causes joint stiffness other is arthroplasty of the affecting joint with the help of custom-made prostheses but this procedure is too costly thus we opted for the extended curettage with bone cement with bone grafting (Sandwich technique) with plating.
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