Banerjee Samik, Sabui Kanchan Kumar, Mondal Jayanta, Nath Chinmoy, Pal Dilip Kumar
Department of Trauma and Orthopaedics, Epson and St Helier University Hospital NHS Trust, Wrythe Ln, Carshalton, Surrey, SM5 1AA, UK.
Orthopedics. 2012 Dec;35(12):e1826-31. doi: 10.3928/01477447-20121120-34.
Hydatid disease is a parasitic tapeworm infection caused by the Echinococcus species. Involvement of the long tubular bones is rare in hydatid bone disease. Patients are initially asymptomatic and usually present at a later stage of the disease when the bony lesions are extensive. Diagnosing bone hydatid disease is challenging, even in endemic regions, and a high index of suspicion is required because the radiologic findings often mimic other bone pathologies. Recurrence following treatment can occur after a long period of quiescence.This article describes a case of hydatid disease in a 62-year-old woman with extensive diaphyseal tibial involvement. She was treated with initial chemotherapy followed by extended curettage, polymethylmethacrylate cementation, and intramedullary fixation. Functional outcome was excellent, with no recurrence at 60-month follow-up. She was fully weight bearing with no pain or discomfort and had full hip, knee, and ankle range of motion.This case was important due to its rarity, the diagnostic challenge it presented, and the composite nature of the treatment used to avoid recurrence. Diaphyseal bone hydatidosis can be initially treated like a low-grade malignant tumor with curettage and high-speed burring, followed by filling the defect with polymethylmethacrylate cement. The composite treatment of chemotherapy with the surgical protocol described offers a reasonable chance of long-term disease suppression. Recurrent disease can be treated with repeat curettage and cementation. Wide excision with reconstruction of the resulting defect should only be considered for recalcitrant diaphyseal hydatid disease.
包虫病是由棘球绦虫属引起的一种寄生虫性绦虫感染。在包虫骨病中，长管状骨受累较为罕见。患者最初无症状，通常在疾病后期出现，此时骨病变已广泛。即使在流行地区，诊断骨包虫病也具有挑战性，由于影像学表现常与其他骨病变相似，因此需要高度怀疑。治疗后复发可能在长时间静止期后发生。本文描述了一例62岁女性的包虫病病例，其胫骨骨干广泛受累。她首先接受了化疗，随后进行了扩大刮除、聚甲基丙烯酸甲酯骨水泥填充和髓内固定。功能结果良好，60个月随访时无复发。她完全负重，无疼痛或不适，髋关节、膝关节和踝关节活动范围正常。该病例因其罕见性、所呈现的诊断挑战以及为避免复发而采用的综合治疗性质而具有重要意义。骨干骨包虫病最初可像治疗低度恶性肿瘤一样进行刮除和高速磨钻，随后用聚甲基丙烯酸甲酯骨水泥填充缺损。所述手术方案与化疗的综合治疗提供了长期抑制疾病的合理机会。复发性疾病可通过重复刮除和骨水泥填充进行治疗。对于难治性骨干包虫病，仅应考虑广泛切除并重建由此产生的缺损。
