Nachimuthu Gurusamy, Arockiaraj Justin, Krishnan Venkatesh, Sundararaj Gabriel David
Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Orthop. 2014 Nov;48(6):617-20. doi: 10.4103/0019-5413.144238.
Hemophilic pseudotumor involving the spine is extremely uncommon and presents a challenging problem. Preoperative planning, angiography, intra and perioperative monitoring with factor VIII cover and postoperative care for hemophilic pseudotumor is vital. Recognition of the artery of Adamkiewicz in the thoracolumbar junction helps to avoid intraoperative neurological injury. We report the case of a 26-year-old male patient with hemophilia A, who presented with a massive pseudotumor involving the first lumbar vertebra and the left iliopsoas. Preoperative angiography revealed the artery of Adamkiewicz arising from the left first lumbar segmental artery. Excision of pseudotumor was successfully carried out with additional spinal stabilization. At 2 years followup, there was no recurrence and the patient was well stabilized with a satisfactory functional status. Surgical excision gives satisfactory outcome in such cases.
累及脊柱的血友病性假肿瘤极为罕见，是一个具有挑战性的问题。血友病性假肿瘤的术前规划、血管造影、围手术期使用凝血因子 VIII 覆盖进行监测以及术后护理至关重要。识别胸腰段交界处的 Adamkiewicz 动脉有助于避免术中神经损伤。我们报告一例 26 岁男性甲型血友病患者，其出现一个巨大假肿瘤，累及第一腰椎和左髂腰肌。术前血管造影显示 Adamkiewicz 动脉发自左第一腰段动脉。成功切除假肿瘤并进行了额外的脊柱稳定手术。随访 2 年，无复发，患者病情稳定，功能状态良好。在这类病例中，手术切除可取得满意的效果。
