Noguchi Takashi, Sakamoto Akio, Kakehi Kensaku, Matsuda Shuichi
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan.
World J Orthop. 2024 Mar 18;15(3):302-309. doi: 10.5312/wjo.v15.i3.302.
Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues, occurring in hemodialysis patients. Calcium phosphate crystals are mainly composed of hydroxyapatite, which is highly infiltrative to tissues, thus making complete resection difficult. An adjuvant method to remove or resolve the residual crystals during the operation is necessary.
A bicarbonate Ringer's solution with bicarbonate ions (28 mEq/L) was used as the adjuvant. After resecting calcium phosphate deposits of tumoral calcinosis as much as possible, while filling with the solution, residual calcium phosphate deposits at the pseudocyst wall can be gently scraped by fingers or gauze in the operative field. A 49-year-old female undergoing hemodialysis for 15 years had swelling with calcium deposition for 2 years in the shoulders, bilateral hip joints, and the right foot. A shoulder lesion was resected, but the calcification remained and early re-deposition was observed. Considering the difficulty of a complete rection, we devised a bicarbonate dissolution method and excised the foot lesion. After resection of the calcified material, the residual calcified material was washed away with bicarbonate Ringer's solution.
The bicarbonate dissolution method is a new, simple, and effective treatment for tumoral calcinosis in hemodialysis patients.
肿瘤性钙化是一种以关节外软组织中磷酸钙晶体沉积为特征的病症，见于血液透析患者。磷酸钙晶体主要由羟基磷灰石组成，对组织具有高度浸润性，因此完全切除困难。术中需要一种辅助方法来去除或溶解残留晶体。
使用含碳酸氢根离子（28 mEq/L）的碳酸氢林格液作为辅助剂。在尽可能切除肿瘤性钙化的磷酸钙沉积物后，在填充该溶液时，手术视野中残留于假囊肿壁的磷酸钙沉积物可用手指或纱布轻轻刮除。一名49岁女性，接受血液透析15年，肩部、双侧髋关节和右脚出现钙沉积肿胀2年。切除了肩部病变，但钙化仍存在并观察到早期再沉积。考虑到完全切除的困难，我们设计了一种碳酸氢盐溶解方法并切除了足部病变。切除钙化物质后，用碳酸氢林格液冲洗残留的钙化物质。
碳酸氢盐溶解法是治疗血液透析患者肿瘤性钙化的一种新的、简单有效的方法。
