BACKGROUND Epithelioid angiosarcoma(EA)is an aggressive,malignant endothelial-cell tumor of vascular or lymphatic origin.EA often arises from deep soft tissues such as pleura,breast,bone and gastrointestinal tract.It usually affects patients aged 60-70 years and is associated with high recurrence and metastasis rates with surgical resection as the primary treatment of choice.Overall survivals are generally poor,ranging from 6 to 16 months.More than 50%of patients died of disease within 2 to 3 years of diagnosis.CASE SUMMARY We present a rare case of EA of the cervical spine causing a C6 pathological fracture complicated by severe kyphosis.The patient received C4-7 posterior laminectomy and C2/3/4/7/T1 transpedicular screw fixation,followed by anterior C5-6 corpectomy with allograft bone fusion and cervical plate fixation.Postoperative radiotherapy was administered without delay.However,the patient died of rapidly progressive acute respiratory distress syndrome 3 weeks after the second surgery.CONCLUSION EA with spinal involvement is extremely rare.Early detection and cord decompression may prevent neurological deterioration and preserve better quality of life.
In this article,we comment on the article by Oommen et al.Oommen et al provided a comprehensive overview of the management of hip centre restoration in total hip arthroplasty(THA)for childhood hip disorder sequelae.Given the developmental disparity in this population,specific preoperative planning is an essential prerequisite for the success of THA procedures.In the review by Oommen et al,assessments of acetabular and femoral anatomic variations were fully described.However,spinal malalignment and stiffness are common in physical and radiological examinations and should be taken into careful consideration when planning surgical procedures.Poor outcomes of THA for patients with comorbid hip and spinopelvic pathologies have been widely reported,especially for hips with childhood disorder sequelae.Therefore,in this editorial,we would like to emphasize the need for a thorough hip-spine evaluation of patients with childhood hip disorder sequelae before THA.
Introduction: Pigmented villonodular synovitis (PVNS) of the spine is a rare condition, with only a limited number of cases documented in the medical literature. In this study, we review imaging findings of two cases of PVNS arising in the spine. Case 1: A 52-year-old male presented with right thigh pain of unclear etiology. His condition subsequently deteriorated and he was referred to our hospital. MRI revealed a spinal tumor with high intensity on T1-weighted imaging (T1WI) and iso-intensity on T2WI in the right L2/3 intervertebral foramen. The tumor exhibited heterogeneous enhancement on contrast-enhanced MRI. Computed tomography (CT) myelography showed the presence of an epidural tumor within the right L2/3 intervertebral foramen, situated externally to the spinal canal and compressing the dura mater. Notable scalloping was observed in the posterior margin of the L2 vertebral body on CT images. Case 2: A 78-year-old male presented with a complaint of muscle weakness of the left upper limb. His gait gradually deteriorated, which led to suspicion of cervical myelopathy. A tumor was observed on plain MRI and exhibited low to iso-intensity on T1WI and high intensity on T2WI. The tumor was in the left C7/T1 intervertebral segment and the spinal cord was compressed from the left side. CT showed destruction of the medial aspect of the left C7 vertebral arch. Conclusion: In spinal PVNS, the signal intensity on MRI is dependent on the timing of hemorrhage within the tumor, and there are no distinctive features. However, if an extradural tumor is suspected and CT shows bone erosion, scalloping or osteolytic changes, PVNS should be considered as a differential diagnosis.
背景:脊柱骨折最高发部位是胸腰段,其症状为后背部疼痛、后凸畸形、活动受限,或伴脊髓神经损伤引发下肢疼痛、麻木甚至截瘫等并发症。有限元法是一种数字化的计算机建模技术,能真实模拟实物模型并进行受力分析。目的:综述有限元法在脊柱胸腰段骨折中的应用。方法:在中英文文献数据库PubMed、Web of Science、中国知网中检索2024年3月之前发表的有限元分析法在脊柱胸腰段骨折中应用的相关文献,中英文检索词为“有限元分析法(finite element analysis methods)”“生物力学(biomechanical phenomena)”“应力分析(stress analysis)”“胸腰椎骨折(thoracolumbar fractures)”“脊柱骨折(spinal fractures)”,最终纳入55篇文献。结果与结论:①通过有限元法对不同病因(骨质疏松性、创伤性、病理性)导致的胸腰椎骨折进行探索,有利于对各种类型胸腰椎骨折的生物力学特征有更加深刻的认识,完善对胸腰椎骨折的个性化和精细化治疗;②单一样本或数量较少样本的有限元分析具有偶然性,未来的有限元分析需要更大的样本数量来减少样本偶然性带来的误差;③仅骨骼的刚性结构不能满足实物的完整性所具有的生物力学工况,未来的有限元模型需要尽可能纳入实物的所有结构(例如肌肉、韧带等软组织);④有限元法在骨质疏松性和创伤性胸腰椎骨折方面的研究较多,未来需要进行更加深入的研究;病理性胸腰椎骨折领域的研究较少,未来研究范围较广。
