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广泛的肱骨和肩胛骨包虫病:一例独特病例报告及管理策略的全面综述

Extensive humerus and scapula hydatidosis: A unique case report and comprehensive review of management strategies.

作者信息

Saberi Sadegh, Naghizadeh Hamed, Bagheri Nima, Saffar Hana, Afshar Zeinab Mohseni, Khabiri Seyyed Saeed

机构信息

Joint Reconstruction Research Center, Department of Orthopedics, Tehran University of Medical Sciences, Iran.

Department of Pathology, Cancer Institute, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Int J Surg Case Rep. 2024 Dec;125:110503. doi: 10.1016/j.ijscr.2024.110503. Epub 2024 Oct 23.

Abstract

INTRODUCTION AND IMPORTANCE

Bone hydatidosis is a rare manifestation of Echinococcus infection, presenting significant diagnostic and therapeutic challenges. This case report describes the successful management of an extensive hydatid disease involving the entire humerus and scapula.

CASE PRESENTATION

A 44-year-old male presented with progressive right arm pain and swelling. Imaging studies revealed extensive hydatid cysts throughout the humerus and scapula. Positive ELISA confirmed the diagnosis for anti-Echinococcus antibodies.

CLINICAL DISCUSSION

Treatment involved a multidisciplinary approach. The patient received preoperative Albendazole for six weeks. The surgical intervention included total humerus endoprosthesis replacement and extended curettage of the scapula. Intraoperative scolicidal agent (povidone‑iodine) was used. Postoperative anthelmintic therapy was administered for three months. At five-year follow-up, the patient remained disease-free with satisfactory upper limb function. No recurrence was observed, although the patient declined further corrective surgery for prosthetic subluxation.

CONCLUSION

This case highlights the efficacy of a comprehensive approach to extensive bone hydatidosis, combining wide resection, prosthetic reconstruction, and perioperative anthelmintic therapy. The successful outcome supports the use of total bone endoprosthesis in suitable cases of extensive long-bone hydatidosis. Long-term follow-up is crucial due to the risk of recurrence.

摘要

引言与重要性

骨包虫病是棘球绦虫感染的一种罕见表现形式,在诊断和治疗方面存在重大挑战。本病例报告描述了一例累及整个肱骨和肩胛骨的广泛性包虫病的成功治疗过程。

病例介绍

一名44岁男性因右臂进行性疼痛和肿胀前来就诊。影像学检查显示肱骨和肩胛骨布满了包虫囊肿。酶联免疫吸附测定(ELISA)呈阳性,确诊为抗棘球绦虫抗体。

临床讨论

治疗采用多学科方法。患者术前服用阿苯达唑六周。手术干预包括全肱骨假体置换和肩胛骨扩大刮除术。术中使用了杀头节剂(聚维酮碘)。术后进行了三个月的驱虫治疗。在五年的随访中,患者疾病无复发,上肢功能良好。尽管患者拒绝了因假体半脱位而进行的进一步矫正手术,但未观察到复发情况。

结论

本病例突出了综合治疗广泛性骨包虫病的有效性,该方法包括广泛切除病灶、假体重建以及围手术期驱虫治疗。成功的治疗结果支持在合适的广泛性长骨包虫病病例中使用全骨假体。由于存在复发风险,长期随访至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e561/11629264/fb2702d39560/gr1.jpg

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