片側皮質骨切除後に加温処理骨移植で再建を行った大腿骨傍骨性骨肉腫の1例

Hemicortical Excision of a Parosteal Osteosarcoma of the Femur and Reconstruction with Pasteurized an Autogenous Cortical Bone Graft. Case Report

　傍骨性骨肉腫(POS)の治療は広範切除が第一選択である．大腿骨遠位POSに対して，片側皮質骨切除を行った症例を報告する．症例は52歳の男性で単純X線像で大腿骨骨幹から遠位骨幹端後面に骨皮質に連続する膨隆性骨病変を認め，MRIでは髄腔に異常はなかった．生検でPOSと診断し，1cmの切除縁で片側皮質骨切除を行い加温処理骨で再建した．術後2年の現在，骨癒合は得られ患肢機能は97％である．再発・転移は認めない．大腿骨POSに対して片側皮質骨切除後に加温処理骨で再建し成績は良好である．

　Resection with a wide margin is the treatment of choice for parosteal osteosarcoma.　We report a case of parosteal osteosarcoma of the posterior aspect of the distal femur that was treated by hemicortical excision.　The patient was a 52-year-old male in whom radiography revealed a lobulated, broad-based mineralized mass adjacent to the posterior aspect of the distal femur.　There was no evidence of intramedullary invasion on MRI.　A pathological diagnosis of parosteal osteosarcoma was made on the basis of examination of an open-biopsy specimen.　Hemicortical excision with a 1-cm wide margin was performed and followed by reconstruction with heat-treated bone.　Two years postoperatively bone union was complete, and the functional outcome according to the Musculoskeletal Tumor Society Score (MSTS) was 97%.　There was no evidence of local recurrence or metastasis.　Hemicortical excision of a parosteal osteosarcoma of the distal femur and reconstruction with heat-treated bone provided a good oncological and functional outcome.