RESUMO
We describe the management of a young boy with mild haemophilia A and a massive iliac pseudotumour with a multi modality approach involving factor replacement, radiation therapy, embolization and surgery. The patient was initially treated with recombinant factor VIII and radiation therapy. Because of inadequate response and worsening of bony erosion, the patient had a preoperative embolization followed by surgical excision. The surgical procedure was associated with minimal blood loss and the patient had a relatively smooth postoperative course with no physical morbidity. This case illustrates successful aggressive management of a large, proximally located pelvic pseudotumour, which resulted in an excellent outcome despite the need for a normally morbid operation.
Assuntos
Doenças Ósseas/terapia , Granuloma de Células Plasmáticas/terapia , Hemofilia A/complicações , Ílio , Adolescente , Terapia Combinada/métodos , Embolização Terapêutica/métodos , Fator VIII/uso terapêutico , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To determine the accuracy of computer-assisted fluoronavigation for percutaneous iliosacral screw placement. MATERIALS AND METHODS: A fluoronavigation system (Stryker Navigation System, Stryker Leibinger, Kalamazoo, MI) was used to guide the placement of four iliosacral screws into the S-1 bodies of each of five cadaveric pelvic specimens with intact soft tissues. Accuracy of screw placement was verified by radiographs, CT scans, and direct dissection. RESULTS: All 20 screws were placed accurately without complications. Nineteen screws were completely contained within the osseous "safe zone." On direct dissection, one screw was noted to have penetrated the S-1 foramina by 3 mm without impingement on the nerve root. This was not detected on radiograph or CT scan. CONCLUSION: The results of this study support the safety and accuracy of computer-assisted fluoronavigation for iliosacral screw placement. The advantages include decreased fluoroscopic time, real-time simultaneous visualization of all three views (inlet, outlet, and lateral), and increased accuracy of placement. Clinical study is warranted.