以血管栓塞、刮除及骨移植治療下顫骨動脈瘤性骨囊腫之病例報告

動脈瘤性骨囊腫是一種罕見的非腫瘤性骨病變，通常較好發於長骨或是脊柱，發生在顎骨區的僅占所有病例的2％。顎骨區發生此病灶時，可以為單室性、多室性、肥皂泡沫狀、或是蜂窩狀的放射線可透性影像，而且大部分都會造成皮質骨的擴張、甚至骨穿孔。若僅憑X光影像易與其他顎骨囊腫性病灶混淆，並容易在術中因止血不易而造成手術併發症。本篇病例報告，為一位38歲女性患者，於環口X光影像上發現右側下顎骨體與骨角處有一邊緣界限模糊之放射線可透性病灶，經電腦斷層檢查，呈現一造影增強的顎骨病灶，並於切片檢查時，經由空針抽吸發現該病灶有高血流速的特徵；故會同放射科醫師，於術前先行以血管攝影確認病灶之血流強度，並施以血管栓塞術降低術中出血的風險，再由手術醫師進行病灶刮除術，同時以自體脛骨移植重建下顎骨缺損區域，以加速骨癒合及降低術後發生病理性骨折的風險。術後追蹤迄今，骨癒合良好﹒亦無任何復發跡象。

關鍵字

動脈瘤性骨囊腫；血管栓塞術；顎骨

並列摘要

Aneurysmal bone cysts(ABCs) are relatively rare, osteolytic lesions. They are mainly found within the long bones, and only 2% occur in the jaws. The characteristic radiologic features of jaw bone ABCs varied from mainly unilocular radiolucencies to multilocular radiolucencies with honeycomb or soap bubble-like appearances. The radiographic features are not pathognomonic and are sometimes confusing. Surgical complication such as massive bleeding could happen if there's no appropriate preoperative evaluation. This is a 38-year-old female without other major systemic disease. Her mandible lesion was found by her family dentist during regular dental x-ray examination. Then she was referred to our department for further management. We arranged head and neck CT scan and found the contrast-enhancing jaw bone lesion on the CT scan images. Before we did the bone biopsy, we made the bur-hole on the cortex and needle aspiration which revealed active blood f1ow. Owing to the highly suspected high flow vascular lesion, we asked the radiologist to do the angiography and transcatheter embo1ization before surgery. Then we did the surgery inc1uding curettage and simultaneously autogenous tibia bone graft reconstruction without massive intraoperative bleeding or other surgical complications. Jaw bone ABCs are rare and difficult to diagnose We have reported the disease profile, diagnosis and treatment course and prognosis for this patient. In the future, these data may be helpful for differential diagnosis and treatment options of patients with similar findings and be a basis of further studies.

並列關鍵字

aneurysmal bone cyst ； jaw bone ； transcatheter embolization

國際替代計量

以血管栓塞、刮除及骨移植治療下顫骨動脈瘤性骨囊腫之病例報告

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