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患者,女性,26岁。因腰骶部及左下肢反复疼痛2年,加重1周,于1997年12月4日入院。2年前腰骶部疼痛,口服止痛药后好转。1年后再次发作,针炙治疗后好转,近1周症状加重,马鞍区有麻木感,以夜间痛为重,白天缓解。摄X线片示:骶尾骨密度均增高,其周边极不规则,下缘呈“菜花样”改变,其内可见多房样密度减低区,以“骶椎管占位性病变”收住院。 入院检查:胸片、心电图正常,血沉2 mm/h,碱性磷酸酶367 u/L(正常50～112 u/L),CT示骶尾骨明显膨大,形态极不规则,下半部类似“珊瑚岛”样及“火山爆发”样变,密度极不均匀。右半部以成骨为主,骨质密度极高,类似“象牙样”变;左半部骨质密度极不均匀,可见多发性大小不等的圆形及不规则形骨质破坏缺损区。其中一缺损区最大达2.5 cm×4.0cm,呈丘样突入骶管,使骶管变窄变形。双侧骶髂关节面紊乱且畸形,CT显示:骶骨肿瘤样变,可能为成骨性骨肉瘤。于1997年12月9日在硬膜外麻下行骶管探查减压及活检术,
Patient, female, 26 years old. Due to repeated pain in the lumbosacral and left lower extremities for 2 years, an increase of 1 week was admitted on December 4, 1997. Pain in the lumbosacral area 2 years ago, improved after taking oral pain medications. One year later, she developed another episode. After being treated with acupuncture, her acupuncture treatment improved. Symptoms worsened in the past 1 week. There was numbness in the saddle area and nighttime pain was relieved during the day. The X-ray film showed that the bone density of the appendix was increased, the circumference of the appendix was irregular, and the lower edge was changed by “vegetable pattern”. The multiple-chamber-like density decreased area was seen in the patient and was taken as “occupying lesion of the sacral spinal canal”. Admission examination: chest radiograph, ECG normal, ESR 2 mm/h, alkaline phosphatase 367 u/L (normal 50 to 112 u/L), CT shows that the sacrococcygeal bone is significantly enlarged, the shape is very irregular, the lower half is similar to Coral islands and volcanic eruptions are very heterogeneous. The right half is dominated by osteogenesis. The bone density is very high and resembles the change of “ivory”. The bone density in the left half is very uneven, and the circular and irregular bone destruction of multiple sizes are seen in the defect area. . One of the defects was up to 2.5 cm x 4.0 cm. It appeared as a dome-like protrusion into the fistula, which narrowed the fistula. The bilateral sacroiliac joints were disordered and deformed. CT showed a metastatic appearance of the sacrum, which may be an osteogenic osteosarcoma. On December 9, 1997, under the anesthesia of the epidural anesthesia, catheter decompression and biopsy were performed.