Castro José Antonio Enríquez, Hernández Mercedes, Sierra Alejandro Cedillo, Méndez Josefina Molina, Macías C Carlos Roberto
Hospital General de México.
Acta Ortop Mex. 2007 Sep-Oct;21(5):289-95.
Treatment of bone sarcomas is aimed in healing and secondarily rescuing the limb. With the use of chemotherapy, radiation therapy, new prostheses and availability of graft, now most tumors can be resected, reducing functional deficit.
To present a surgical option in management of osteosarcoma of distal tibia.
Fifteen year-old man, starting in April 2003 with a mass in the left ankle area. June 2003 pulsatile progressive pain started, increased with activity, decreased with rest. November 2003 the physical exam: limping by left lower limb, with a tumor in the posteromedial ankle surface (3 x 2 cm), hard, not movable, regular edges, painful on palpation, Radiographic observations (November 2003), showed blastic oval stone image (4 x 3.5 cm) with expanded posterior and medial cortices with periosteal reaction. The initial biopsy report (chondroblastoma) was not consistent with the diagnostical assumption. So resection was performed 10 cm wide, placing a methylmethacrylate spacer. The final histological report was positive to osteogenic sarcoma. The patient received 11 sessions of chemotherapy. The reconstruction of the distal tibia and arthrodesis with autologous graft from the fibula, heterologous graft and stabilization with transcalcaneal nail, was done in March 2005.
Successful evolution without tumor activity with graft integration to arthrodesis and plantigrade gait.
骨肉瘤的治疗旨在治愈并其次挽救肢体。随着化疗、放疗、新型假体的使用以及移植物的可得性，现在大多数肿瘤都可以切除，从而减少功能缺陷。
介绍一种治疗胫骨远端骨肉瘤的手术方案。
一名15岁男性，于2003年4月开始出现左踝区肿物。2003年6月开始出现搏动性进行性疼痛，活动时加重，休息时减轻。2003年11月体格检查：左下肢跛行，内踝后内侧有一肿物（3×2厘米），质地硬，不可活动，边缘规则，触诊疼痛。影像学检查（2003年11月）显示成骨椭圆形石样影像（4×3.5厘米），后内侧皮质膨胀，有骨膜反应。最初的活检报告（软骨母细胞瘤）与诊断假设不符。于是进行了10厘米宽的切除，置入甲基丙烯酸甲酯间隔物。最终组织学报告显示骨肉瘤阳性。患者接受了11个疗程的化疗。2005年3月，采用取自腓骨的自体移植物、异体移植物进行胫骨远端重建和关节融合，并使用跟骨钉进行固定。
病情进展顺利，无肿瘤活动，移植物与关节融合，步态正常。
