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題 名 | Unusual Bleeding of Aneurysmal Bone Cyst in the Upper Thoracic Spine=上胸椎動脈瘤骨囊腫合併異常出血 |
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作 者 | 陳世豪; 黃聰仁; 薛綏; 李晏瑤; 許文蔚; | 書刊名 | 長庚醫學 |
卷 期 | 25:3 2002.03[民91.03] |
頁 次 | 頁183-189 |
分類號 | 416.66 |
關鍵詞 | 動脈瘤骨囊腫; 上胸椎; 再出血; Aneurysmal bone cyst; Upper thoracic spine; Rebleeding; |
語 文 | 英文(English) |
中文摘要 | 動脈瘤骨囊腫是一良性,但會迅達局部擴張、血管增生、骨融解的骨病變,主犯二十歲前的青少年,多發生在四肢長骨的?板近端。當病灶侵犯脊椎部位。侵襲破壞椎弓、椎體使其骨折、多量出血、也會壓迫脊髓神經,致有多樣的臨床表徵。手術祛除骨囊腫、植骨術、血管栓塞術及術後放射治療,常因囊腫生長部位、速度、出血程度、神經壓迫輕重而有不同。文獻上少有強調頸胸椎處的巨大動脈瘤骨囊腫,再發出血使神經壓迫再度惡化時,如何應變之道。我們提出的病例報告是一名15歲男孩,因上胸椎動脈瘤骨囊腫出血壓迫脊髓症狀,先以後位囊腫清除、減壓、胸椎內固定手術,再以影像輔助之胸腔鏡前位手術,切除囊腫及前方椎體融合。不幸一個月內再發出血、急速下肢無力,緊急後位清除血腫、囊腫界面徹底刮除,使神經症狀復原,再補以術後放射治療,目前十八個月追蹤,並無再發現象。對此上胸椎處巨大、有侵襲性的動脈瘤骨囊腫,再發性異常出血壓迫脊髓,並不適合血管栓塞,以免脊髓缺血之虞。重建穩定脊椎架構,前後位徹底刮除囊腫是首要課題。因有再發出血之虞,術後放射治療,密切追蹤一年以上是必要的。 |
英文摘要 | Aneurysmal bone cyst (ABC) is a benign bone lesion and commonly affects young adolescents. It usually grows rapidly with hypervascularity. In the spine, it can cause extensive bone destruction and compress neural structures with eventual vertebral collapse. Operative management of such a lesion may be complicated by profuse hemorrhage. Herein, we report a 15-year-old boy who had an acute exacerbation of spinal cord compression because of an ABC in the upper thoracic region. With a two-staged operation that complicating with profuse intraoperative bleeding, decompressive curettage and stabilization of the vertebral column were assured. However, abrupt neurologic deterioration occurred because of rebleeding with spinal cord compression 1 month postoperatively. Secondary decomppressive curettage and following local radiotherapy were undertaken to cure the disease. Neurological recovery and healing of spinal ABC could be expected if the lining of a cyst had been totally removed. At the 18-month follow-up examination, he was neurologically intact and without any backache, leg pain or gait distubance. |
本系統中英文摘要資訊取自各篇刊載內容。