Munguva pfupi yapfuura, Liu Hucheng, mutungamiriri weDhipatimendi reBone uye Soft Tissue Oncology paFirst Affiliated Hospital yeNanchang University, akapedza "pelvic tumor resection + sacral osteotomy + pelvic replacement + hip replacement + lumbar pedicle screw internal fixation" neLDK yakagadzirirwa pelvic prosthesis. , uye oparesheni yakafamba zvakanaka.
Murwere akaendeswa kuchipatara chekunze kuti adzokorore kurwadziwa shure uye kusagadzikana.Mushure mokupedza kuongorora kwakabatana nehudyu, murwere akanzi angave ane osteo-inouraya lesion, asi haana kuiteerera, uye ipapo zviratidzo zvake zvekurwadziwa zvakawedzera uye kufamba kwake kwakanga kusina kukwana.Ipapo murwere akauya kuDhipatimendi reBone uye Soft Tissue Oncology yeFirst Affiliated Hospital yeNanchang University kuzorapwa.
Mushure mekupinzwa muchipatara uye kupedza pelvic bone biopsy, murwere akaonekwa aine osteosarcoma.Mushure mekunge chirongwa chekuvhiya chakakwana chakaitwa pamwe chete nemadhipatimendi akawanda uye preoperative gadziriro yakapera, Mutungamiri Liu Hu Cheng timu yakaita "pelvic tumor resection + sacral osteotomy + pelvic replacement + hip replacement + lumbar arch screw internal fixation" kumurwere.
Tsanangudzo:
Murwere, mukadzi, 52 makore
Chichemo:
Kupfuura mwedzi mitatu mushure mechemotherapy yepelvic bone osteosarcoma
Nhoroondo yezvino yekurapa:
Murwere akanyunyuta kuti muna 2022-10, pakanga pasina chikonzero chiri pachena chekudzoka shure kwemarwadzo ekudzokera shure uye kusagadzikana, nekurwadziwa uye kuzvimba, pamwe chete nemarwadzo ari kuruboshwe rwezasi, iri muhudyu yekuruboshwe, kuruboshwe rwezasi, rutivi rwemashure. yehudyu, nechekumashure kwemhuru kune rutsoka rworuboshwe, chiveve pasi petsoka yeruboshwe, kurwadziwa kwakawedzera mushure mekugara kwenguva refu uye kufamba, uye kunogona kusunungurwa pakuzorora, panguva iyo pasina kutariswa kwakabhadharwa, uye ipapo zviratidzo zvinorwadza zvakatanga kuwedzera uye zvisingakwanisi kufamba.
MRI yakaratidza: 1) chiratidzo chisina kujairika cheruboshwe iliac bone, tichifunga nezvekugona kwechirwere chakaipa;2) mvura shoma muhudyu yekuruboshwe.Hapana kurapwa kunokosha kwakapiwa, uye zvino murwere wacho akapinzwa muchipatara kuti awedzere kurapwa.
Clinical diagnostic:
"Post-chemotherapy myelosuppression" kubvuma
Maitiro akarongwa ndee "pelvic tumor resection + sacral osteotomy + pelvic replacement + hip replacement + internal fixation with lumbar pedicle screw"
Sayenzi inotumirwa kunoongororwa:
Bundu rekuruboshwe repelvic rakatumirwa kunoongororwa: mapfupa emapfupa asina kuumbwa, saizi 19.5X17X9 cm, aine nyama yemhasuru yakasungirirwa, saizi 16.5X16X3.5 cm, kucheka mativi mazhinji, 1.5 cm kubva kumucheto wecautery, hukuru hwakaonekwa munyama yetsandanyama. , saizi 8X6.5X4.5 masendimita, grey-tsvuku, yakaoma, uye yakanyatso kutsanangurwa pakati penzvimbo yakatarisana nepfupa.
Kuruboshwe sciatic nerve bundu: grey-tsvuku isina kuumbwa tishu, saizi 9.5X3X3m, grey-chena grey-tsvuku yakaoma pane yakachekwa pamusoro.
Microscopically, bundu airatidza yakasimba lamellar kuparadzirwa, nechisimba peripheral fibrofat, chinjikira tsandanyama uye tsinga tishu, pamwe masero masero, pachena nucleoli, nyore kuona yenyukireya schizophrenia, pachena heterotypes uye yakawanda necrosis.
Pathologic kuongororwa:
(Kuruboshwe pelvis) Yakasanganiswa nekiriniki, kufungidzira uye nhoroondo, yaienderana nemhinduro mushure mechemotherapy yemhando yepamusoro-giredhi osteosarcoma (yakajairika mhando).
Huvos grading: giredhi II (zvinyoro inoshanda chemotherapy,> 50% tumor tissue necrosis, inopona bundu tishu).
Tissue cautery margin: hapana kubatanidzwa kweronda kwakaonekwa.
(left sciatic nerve) inooneka lesion kubatanidzwa: 2 mamwe lymph nodes akaonekwa, hapana metastasis inoonekwa (0/2) Immunohistochemistry inoratidza: CK(-);Vimentin(3+);Ki-67(75%+);SATB2(+) ;IMP3(+);MDM2(+);P16(+);S-100(kupararira +);H3.3G34W(-);Brachyury(-);Desmin(-);CD68(-).
Kuronga Kuvhiya:
Pelvic tumor resection + sacral osteotomy + pelvic kutsiva + hip kutsiva + lumbar pedicle screw mukati mekugadzirisa.
Preoperative
Postoperative
Chiremba Wokuvhiya Nhanganyaya
Prof. Hucheng Liu
Yekutanga Yakabatana Chipatara cheNanchang University Orthopedic Hospital
Mukuru, Dhipatimendi reBone uye Soft Tissue Oncology
Chiremba mukuru, Associate Purofesa, Master's supervisor
Mutungamiriri weBone uye Soft Tissue Tumor Group, Orthopedic Branch, Jiangxi Medical Association
Mutevedzeri waSachigaro weBone uye Soft Tissue Tumor Committee yeJiangxi Physicians Association Orthopedic Branch.
Nguva yekutumira: Kubvumbi-26-2023