M A K A L A H K E P E R A W A T A N M U S K U L O S K E L E T A L

A S K E P P A D A K L I E N D E N G A N O S T E O S A R C O M A

D i s u s u n O l e h : K e l o m p o k 3 / K e l a s A - 2

1 . D e v i A y u K u m a l a s a r i ( 1 3 1 2 1 1 1 3 1 0 9 6 )

2 . N a i l i y a t u l F a r i c h a ( 1 3 1 2 1 1 1 3 1 1 0 2 )

3 . U s w a t u n K h a s a n a h ( 1 3 1 2 1 1 1 3 1 1 0 9 )

4 . T r i s c a H a p r i l i y a n i n g t y a s ( 1 3 1 2 1 1 1 3 2 0 0 7 )

5 . M e y v i t a S a r i R i k e Y . ( 1 3 1 2 1 1 1 3 2 0 1 3 )

6 . S i t i K o m a r i a h ( 1 3 1 2 1 1 1 3 2 0 1 5 )

7 . R i f k y O c t a v i a P ( 1 3 1 2 1 1 1 3 2 0 1 9 )

8 . R i a F i t r i a n i ( 1 3 1 2 1 1 1 3 2 0 2 6 )

P R O G R A M S T U D I S 1 P E N D I D I K A N N E R S

F A K U L T A S K E P E R A W A T A N

U N I V E R S I T A S A I R L A N G G A

S U R A B A Y A

2 0 1 5

i i

K A T A P E N G A N T A R

P u j i d a n s y u k u r k a m i p a n j a t k a n k e h a d i r a t T u h a n Y a n g M a h a E s a k a r e n a

b e r k a t l i m p a h a n r a h m a t d a n k a r u n i a - N y a s e h i n g g a k e l o m p o k d a p a t m e n y u s u n m a k a l a h

K a n k e r T u l a n g d e n g a n b a i k . M a k a l a h i n i m e m b a h a s t e n t a n g A s u h a n K e p e r a w a t a n p a d a

K l i e n d e n g a n K a n k e r T u l a n g d a n A s u h a n K e p e r a w a t a n K a s u s K l i e n d e n g a n

O s t e o s a r c o m a .

P a d a p e n y u s u n a n m a k a l a h i n i , k a m i b a n y a k m e n d a p a t h a m b a t a n , a k a n t e t a p i

d e n g a n b a n t u a n d a r i b e r b a g a i p i h a k t a n t a n g a n i t u b i s a t e r a t a s i . O l e h k a r e n a i t u , k a m i

m e n g u c a p k a n t e r i m a k a s i h y a n g s e b e s a r - b e s a r n y a k e p a d a s e m u a p i h a k y a n g t e l a h

m e m b a n t u d a l a m p e n y u s u n a n m a k a l a h i n i , s e m o g a b a n t u a n n y a m e n d a p a t b a l a s a n y a n g

s e t i m p a l d a r i T u h a n Y a n g M a h a E s a .

K a m i m e n y a d a r i b a h w a m a k a l a h i n i m a s i h j a u h d a r i k e s e m p u r n a a n b a i k d a r i

b e n t u k p e n y u s u n a n m a u p u n m a t e r i n y a . K r i t i k d a n s a r a n s a n g a t k a m i h a r a p k a n u n t u k

p e n y e m p u r n a a n m a k a l a h s e l a n j u t n y a . A k h i r k a t a s e m o g a m a k a l a h i n i d a p a t

m e m b e r i k a n m a n f a a t k e p a d a k i t a s e m u a .

S u r a b a y a , M a r e t 2 0 1 5

P e n y u s u n

i i i

D A F T A R I S I

K A T A P E N G A N T A R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i i

D A F T A R I S I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i i i

B A B 1 P E N D A H U L U A N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1 . 1 L a t a r B e l a k a n g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1 . 2 T u j u a n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1 . 2 . 1 T u j u a n U m u m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1 . 2 . 2 T u j u a n k h u s u s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1 . 3 M a n f a a t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

1 . 3 . 1 M a n f a a t b a g i M a h a s i s w a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

1 . 3 . 2 M a n f a a t b a g i P e r a w a t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

B A B 2 T I N J A U A N P U S T A K A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

2 . 1 A n a t o m i F i s i o l o g i T u l a n g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

a ) T u l a n g b e l a k a n g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

b ) T u l a n g d a d a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

c ) T u l a n g r u s u k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2 . 2 D e f i n i s i O s t e o s a r c o m a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0

2 . 3 E t i o l o g i O s t e o s a r c o m a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0

2 . 4 M a n i f e s t a s i K l i n i s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2

2 . 5 P a t o f i s i o l o g i O s t e o s a r c o m a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2

2 . 6 P e m e r i k s a a n D i a g n o s t i k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 3

2 . 7 P e n a t a l a k s a n a a n O s t e o s a r c o m a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 7

2 . 8 K o m p l i k a s i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 9

2 . 9 P r o g n o s i s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 9

i v

2 . 1 0 W e b o f C a u s a t i o n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 0

B A B 3 A S U H A N K E P E R A W A T A N O S T E O S A R K O M A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3

3 . 1 P e n g k a j i a n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3

3 . 1 . 1 P e m e r i k s a a n F i s i k ( R e v i e w o f S y s t e m ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 4

3 . 1 . 2 P e m e r i k s a a n P e n u n j a n g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 4

3 . 2 D i a g n o s a K e p e r a w a t a n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 5

3 . 3 I n t e r v e n s i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 5

3 . 4 E v a l u a s i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4

B A B 4 A S U H A N K E P E R A W A T A N K A S U S O S T E O S A R K O M A . . . . . . . . . . . . . . . . . . . . . . . . . 3 4

4 . 1 K a s u s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4

4 . 2 A n a l i s a D a t a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9

4 . 3 D i a g n o s a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3

4 . 4 I n t e r v e n s i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 4

4 . 5 E v a l u a s i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 9

B A B 5 P E N U T U P . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 0

5 . 1 S i m p u l a n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 0

5 . 2 S a r a n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 0

D A F T A R P U S T A K A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1

1

B A B 1

P E N D A H U L U A N

1 . 1 L a t a r B e l a k a n g

T u b u h m a n u s i a m e m i l i k i b e r b a g a i m a c a m s i s t e m o r g a n , s a l a h s a t u n y a

a d a l a h s i s t e m m u s k u l o s k e l e t a l . S i s t e m i n i t e r d i r i a t a s t u l a n g , s e n d i , o t o t r a n g k a ,

t e n d o n , l i g a m e n , b u r s a , d a n j a r i n g a n - j a r i n g a n k h u s u s y a n g m e n g h u b u n g k a n

s t r u k t u r - s t r u k t u r t e r s e b u t . S i s t e m m u s k u l o s k e l e t a l m e r u p a k a n s i s t e m y a n g

b e r f u n g s i s e b a g a i p e n u n j a n g b e n t u k t u b u h , m e m b a n t u p r o s e s p e r g e r a k a n s e r t a

m e l i n d u n g i o r g a n o r g a n m a n u s i a y a n g l u n a k .

K a n k e r t u l a n g m e r u p a k a n s a l a h s a t u k e g a n a s a n y a n g t e d a p a t p a d a t u l a n g

s e b a g a i s a l a h s a t u k o m p o n e n p e n y u s u n s i s t e m m u s k u l o s k e l e t a l . K a n k e r t u l a n g

m e r u p a k a n s e b u a h p e n y a k i t d i m a n a s e l - s e l k a n k e r t u m b u h p a d a j a r i n g a n t u l a n g .

K a n k e r t u l a n g t e r j a d i k e t i k a s e l - s e l d i d a l a m t u l a n g m e m b e l a h a t a u b e r k e m b a n g

d e n g a n t i d a k t e r a t u r . J i k a s e l - s e l t u l a n g t e r u s m e m b e l a h t a k t e r a t u r , s e m e n t a r a s e l -

s e l b a r u y a n g t u m b u h i t u t i d a k d i b u t u h k a n t u b u h , m a k a a k a n m e m b e n t u k m a s s a

a t a u j a r i n g a n , y a n g d i s e b u t s e b a g a i t u m o r . B e r b e d a d e n g a n t u m o r j i n a k y a n g t i d a k

m e n y e b a r , k a n k e r a d a l a h t u m o r y a n g g a n a s d a n c e p a t p e n y e b a r a n n y a

( m e d k e s . c o m ) .

K a n k e r t u l a n g t e r b a g i m e n j a d i d u a , y a i t u k a n k e r t u l a n g p r i m e r d a n

s e k u n d e r . K a n k e r t u l a n g p r i m e r a d a l a h k a n k e r y a n g m u n c u l d a n b e r k e m b a n g

l a n g s u n g d i d a l a m t u l a n g s e d a n g k a n k a n k e r t u l a n g s e k u n d e r a d a l a h k a n k e r y a n g

b e r a s a l d a r i b a g i a n t u b u h l a i n y a n g m e n j a l a r k e t u l a n g . S e l u r u h t u l a n g d i d a l a m

t u b u h d a p a t t e r s e r a n g o l e h p e n y a k i t i n i , n a m u n s e b a g i a n b e s a r t e r j a d i p a d a t u l a n g

k a k i d a n l e n g a n . P e n y a k i t i n i d a p a t d i i d a p o l e h a n a k - a n a k h i n g g a o r a n g d e w a s a

( a l o d o k t e r . c o m ) .

B e r d a s a r k a n j e n i s n y a , k a n k e r t u l a n g d a p a t t e r b a g i m e n j a d i o s t e o s a r c o m a ,

c h o n d r o s a r c o m a , e w i n g s a r c o m a , f i b r o s a r c o m a d a n g i a n t c e l l t u m o r

( m e d k e s . c o m ) . O s t e o s a r c o m a a d a l a h k a n k e r t u l a n g p a l i n g u m u m d e n g a n a n g k a

k e m a t i a n 8 0 % s e t e l a h l i m a t a h u n k l i e n d i d i a g n o s i s . O s t e o s a r c o m a k l a s i k

d i d e f i n i s i k a n s e b a g a i s a r c o m a s e l s p i n d e l d e n g a n d e r a j a t m a l i g n a n s i t i n g g i d a n

2

m e m i l i k i c i r i y a n g k h a s y a i t u d e n g a n m e m p r o d u k s i m a t r i k s o s t e o i d .

O s t e o s a r c o m a d i d a p a t k a n p a d a 3 o r a n g p e r 1 0 . 0 0 0 o r a n g d i A m e r i k a ( M a r k ,

2 0 0 2 ) .

P a d a m a k a l a h i n i a k a n d i b a h a s m e n g e n a i k a n k e r t u l a n g , k h u s u s n y a

O s t e o s a r c o m a y a n g m e r u p a k a n j e n i s k a n k e r t u l a n g p a l i n g u m u m y a n g d i t e m u k a n

d a n m e n j a d i p e n y e b a b k e m a t i a n 8 0 % p e n d e r i t a k a n k e r t u l a n g . G e j a l a u m u m p a d a

k l i e n y a n g m e n d e r i t a O s t e o s a r c o m a d i a n t a r a n y a m e n g a l a m i r a s a n y e r i p a d a a r e a

t u l a n g y a n g t e r k e n a t u m o r , b e r a t b a d a n m e n u r u n , k e l e l a h a n , k e s u l i t a n b e r n a f a s

d a n d e m a m a t a u b e r k e r i n g a t p a d a m a l a m h a r i . T i d a k h a n y a d a r i s e g i p e n y a k i t ,

p e n g o b a t a n p a d a k a n k e r t u l a n g s e p e r t i k e m o t e r a p i d a n p e m b e d a h a n , m e m i l i k i

e f e k s a m p i n g y a n g d a p a t m e n g g a n g g u k e n y a m a n a n d a n d a p a t m e n g h a m b a t

a k t i f i t a s k l i e n s e h a r i h a r i .

O l e h k a r e n a i t u , m a h a s i s w a k e p e r a w a t a n s e b a g a i s a l a h s a t u c a l o n t e n a g a

k e s e h a t a n p e r l u m e n g e t a h u i b a g a i m a n a p r o s e s p e r j a l a n a n p e n y a k i t k a n k e r t u l a n g

O s t e o s a r c o m a s e r t a e f e k y a n g d i t i m b u l k a n k e p a d a k l i e n y a n g m e n d e r i t a p e n y a k i t

t e r s e b u t . H a l i n i b e r t u j u a n a g a r m a h a s i s w a p e r a w a t m a m p u b e r t i n d a k s e c a r a

p r o f e s i o n a l d a l a m m e m b e r i k a n a s u h a n k e p e r a w a t a n y a n g s e s u a i p a d a p e n d e r i t a

k a n k e r t u l a n g .

1 . 2 T u j u a n

1 . 2 . 1 T u j u a n U m u m

M a h a s i s w a d i h a r a p k a n m a m p u m e m a h a m i p e n y a k i t p a d a t u l a n g

t e r u t a m a o s t e o s a r c o m a d a n m e m b e r i k a n a s u h a n k e p e r a w a t a n y a n g t e p a t

p a d a k l i e n d e n g a n o s t e o s a r c o m a .

1 . 2 . 2 T u j u a n k h u s u s

1 . M a h a s i s w a m a m p u m e m a h a m i a n a t o m i d a n f i s i o l o g i s i s t e m m u s k u l o

s k e l e t a l

2 . M a h a s i s w a m a m p u m e m a h a m i d e f i n i s i O s t e o s a r c o m a

3 . M a h a s i s w a m a m p u m e m a h a m i e t i o l o g i O s t e o s a r c o m a

4 . M a h a s i s w a m a m p u m e m a h a m i m a n i f e s t a s i k l i n i s O s t e o s a r c o m a

5 . M a h a s i s w a m a m p u m e m a h a m i p a t o f i s i o l o g i O s t e o s a r c o m a

3

6 . M a h a s i s w a m a m p u m e m a h a m i p e m e r i k a s a a n d i a g n o s t i k p a d a k a n k e r

t u l a n g .

7 . M a h a s i s w a m a m p u m e m a h a m i p e n a t a l a k s a n a a n p a d a k a n k e r t u l a n g

M a h a s i s w a m a m p u m e m a h a m i k o m p l i k a s i k a n k e r t u l a n g .

8 . M a h a s i s w a m a m p u m e m a h a m i p r o g n o s i s k a n k e r t u l a n g .

9 . M a h a s i s w a m a m p u m e m a h a m i d a n m e n e r a p k a n a s u h a n k e p e r a w a t a n

p a d a o s t e o s a r c o m a .

1 . 3 M a n f a a t

1 . 3 . 1 M a n f a a t b a g i M a h a s i s w a

S e b a g a i b a h a n p e m b e l a j a r a n d a l a m m e n e n t u k a n a s u h a n k e p e r a w a t a n

y a n g t e p a t t e r u t a m a y a n g b e r h u b u n g a n d e n g a n k a s u s k a n k e r t u l a n g

o s t e o s a r c o m a .

1 . 3 . 2 M a n f a a t b a g i P e r a w a t

M e n j a d i i n f o r m a s i d a n b a h a n b a g i p e n g e m b a n g a n i l m u k e p e r a w a t a n

k h u s u s n y a k e p e r a w a t a n m u s k u l o s k e l e t a l .

4

B A B 2

T I N J A U A N P U S T A K A

2 . 1 A n a t o m i F i s i o l o g i T u l a n g

S i s t e m m u s k u l o s k e l e t a l m e r u p a k a n s i s t e m t u b u h y a n g t e r d i r i d a r i o t o t

( m u s k u l o ) d a n t u l a n g t u l a n g y a n g m e m b e n t u k r a n g k a ( s k e l e t ) . O t o t a d a l a h

j a r i n g a n t u b u h y a n g m e m p u n y a i k e m a m p u a n m e n g u b a h e n e r g i k i m i a m e n j a d i

e n e r g i m e k a n i k ( g e r a k ) . S e d a n g k a n r a n g k a a d a l a h b a g i a n t u b u h y a n g t e r d i r i d a r i

t u l a n g t u l a n g y a n g m e m u n g k i n k a n t u b u h m e m p e r t a h a n k a n b e n t u k , s i k a p d a n

p o s i s i .

F u n g s i s i s t e m M u s k u l o s k e l e t a l :

1 . M e n e n t u k a n b e n t u k t u b u h

2 . M e n y a n g g a b e r a t b a d a n

3 . M e l i n d u n g i o r g a n v i s e r a l

4 . M e m p r o d u k s i s e l d a r a h ( b a g i a n m e d u l l a o s s e u m )

5 . A l a t g e r a k p a s i f , t e m p a t m e l e k a t n y a o t o t u n t u k k e r j a

6 . M e n y i m p a n m i n e r a l k a l s i u m d a n f o s f o r , d i k e l u a r k a n b i l a d i b u t u h k a n

J e n i s t u l a n g t e r d i r i d a r i :

a . T u l a n g r a w a n ( k a r t i l a g o ) a d a l a h t e r s u s u n d a r i s e l - s e l t u l a n g r a w a n , r u a n g

a n t a r s e l t u l a n g r a w a n b a n y a k m e n g a n d u n g z a t p e r e k a t d a n s e d i k i t z a t

k a p u r , b e r s i f a t l e n t u r . S e l - s e l i n i m e n g e l u a r k a n m a t r i k s y a n g d i s e b u t

k o n d r i n . T u l a n g r a w a n m e r u p a k a n b e n t u k k h u s u s j a r i n g a n i k a t d e n g a n

k o n s i s t e n s i m a t r i k s e k s t r a s e l y a n g k e r a s s e h i n g g a m e m n u g k i n k a n

j a r i n g a n i n i m e n a h a n s t r e s m e k a n i k t a n p a t e r b e n t u k n y a d i s t o r s i y a n g

p e r m a n e n . T e r d i r i d a r i : T u l a n g r a w a n h i a l i n , T u l a n g r a w a n e l a s t i s ,

T u l a n g r a w a n f i b r o s a

5

b . T u l a n g K e r a s a d a l a h k u m p u l a n s e l - s e l y a n g m e n g e l u a r k a n m a t r i k s y a n g

m e n g a n d u n g s e n y a w a k a p u r d a n f o s f a t .

T e r d i r i d a r i : t u l a n g p a n j a n g , t u l a n g p i p i h , t u l a n g p e n d e k

R a n g k a T u b u h a d a l a h T u l a n g - t u l a n g y a n g t e r s u s u n s e d e m i k i a n r u p a d e n g a n

s i s t e m t e r t e n t u y a n g d i s u s u n m e n j a d i

a . T u l a n g T e n g k o r a k m e r u p a k a n t u l a n g p e m b e n t u k k e p a l a . T u l a n g - t u l a n g

t e n g k o r a k s e b a g i a n b e s a r d i s u s u n t u l a n g y a n g b e r b e n t u k p i p i h . T u l a n g -

t u l a n g t e r s e b u t s a l i n g b e r h u b u n g a n m e m b e n t u k t e n g k o r a k . D i d a l a m

t e n g k o r a k i n i t e r d a p a t m a t a , o t a k , d a n o r g a n l a i n n y a y a n g t e r l i n d u n g o l e h

t u l a n g - t u l a n g t e n g k o r a k t e r s e b u t . T u l a n g t e n g k o r a k t e r s u s u n a t a s t u l a n g

6

p i p i , t u l a n g r a h a n g , t u l a n g m a t a , t u l a n g h i d u n g , t u l a n g d a h i , t u l a n g u b u n -

u b u n , t u l a n g p e l i p i s , d a n t u l a n g b a j i . A g a r l e b i h j e l a s , p e r h a t i k a n g a m b a r

b e r i k u t .

b . T u l a n g a n g g o t a b a d a n t e r s u s u n o l e h t u l a n g b e l a k a n g , t u l a n g d a d a , t u l a n g

r u s u k , d a n g e l a n g p a n g g u l . M a s i n g - m a s i n g t u l a n g t e r s e b u t m e m b e n t u k

k e s a t u a n . T u l a n g a n g g o t a b a d a n b e r f u n g s i m e l i n d u n g i o r g a n - o r g a n d a l a m

y a n g l u n a k , s e p e r t i j a n t u n g , p a r u - p a r u , g i n j a l , d a n o r g a n l a i n n y a . T e r d i r i

d a r i :

a ) T u l a n g b e l a k a n g

T u l a n g b e l a k a n g t e r s u s u n a t a s r u a s - r u a s t u l a n g y a n g f l e k s i b e l , t e t a p i

k u a t . T u l a n g b e l a k a n g t e r d i r i a t a s 3 3 r u a s , y a i t u 7 r u a s t u l a n g l e h e r , 1 2

r u a s t u l a n g p u n g g u n g , 5 r u a s t u l a n g p i n g g a n g , 5 r u a s t u l a n g k e l a n g k a n g

( s a k r u m ) , d a n 4 r u a s t u l a n g e k o r .

b ) T u l a n g d a d a

T u l a n g d a d a t e r l e t a k d e k a t t u l a n g r u s u k a t a u l e b i h t e p a t n y a d i t e n g a h -

t e n g a h d a d a . T u l a n g d a d a t e r d i r i a t a s b a g i a n h u l u , b a d a n , d a n t a j u

p e d a n g .

7

c ) T u l a n g r u s u k

T u l a n g r u s u k p a d a m a n u s i a t e r d i r i a t a s 2 4 b u a h a t a u 1 2 p a s a n g . T u l a n g

r u s u k m a n u s i a m e m i l i k i f u n g s i s e b a g a i p e l i n d u n g o r g a n - o r g a n d a l a m ,

s e p e r t i j a n t u n g d a n p a r u p a r u . T u l a n g r u s u k m a n u s i a , t e r d i r i a t a s 7 p a s a n g

t u l a n g r u s u k s e j a t i , 3 p a s a n g t u l a n g r u s u k p a l s u , d a n 2 p a s a n g t u l a n g

r u s u k m e l a y a n g .

d ) T u l a n g p a n g g u l

G e l a n g p a n g g u l a t a u t u l a n g p a n g g u l t e r l e t a k d i u j u n g b a w a h t u l a n g

b e l a k a n g . G e l a n g p a n g g u l t e r d i r i a t a s 2 t u l a n g u s u s ( i l i u m ) , 2 t u l a n g

k e m a l u a n ( i s c h i u m ) , d a n 2 t u l a n g d u d u k ( p u b i s ) .

c . T u l a n g a n g g o t a g e r a k p a d a m a n u s i a t e r d i r i a t a s t u l a n g a n g g o t a g e r a k b a g i a n

a t a s ( t a n g a n ) d a n t u l a n g a n g g o t a g e r a k b a g i a n b a w a h ( k a k i ) . M a s i n g - m a s i n g

t u l a n g t e r s e b u t t e r s u s u n o l e h b e b e r a p a t u l a n g . A p a k a h k a m u t a h u p e n y u s u n

t u l a n g a n g g o t a g e r a k b a g i a n a t a s d a n b a g i a n b a w a h ? T u l a n g a n g g o t a g e r a k

b a g i a n a t a s a t a u t a n g a n t e r b e n t u k d a r i t u l a n g l e n g a n a t a s ( h u m e r u s ) , t u l a n g

p e n g u m p i l ( r a d i u s ) , d a n t u l a n g h a s t a ( u l n a ) . A d a p u n t u l a n g p e n y u s u n

a n g g o t a g e r a k b a g i a n b a w a h a d a l a h t u l a n g p a h a ( f e m u r ) , t u l a n g b e t i s

( f i b u l a ) , d a n t u l a n g k e r i n g ( t i b i a ) . U n t u k l e b i h j e l a s n y a , p e r h a t i k a n g a m b a r

b e r i k u t .

8

T u l a n g m e r u p a k a n j a r i n g a n y a n g d i n a m i s . P a d a p r o s e s p e r t u m b u h a n n y a ,

t u l a n g a k a n m e n g a l a m i p r o s e s p e r u s a k a n d a n p e m b e n t u k a n k e m b a l i ( p r o s e s

r e m o d e l i n g ) . A g a r d a p a t t u m b u h d e n g a n b a i k , t u l a n g h a r u s m e m p e r o l e h n u t r i s i

d a n l a t i h a n f i s i k y a n g c u k u p . T u l a n g s e l a n j u t n y a a k a n m e n g a l a m i p r o s e s

p e m b e n t u k a n ( f o r m a t i o n ) d a n p e r o m b a k a n a t a u p e n y e r a p a n ( r e s o r p t i o n ) y a n g

b e r l a n g s u n g s e c a r a t e r u s - m e n e r u s . P e m b e n t u k a n d i t e n t u k a n o l e h a k t i v i t a s

o s t e o b l a s d a n p r o s e s m i n e r a l i s a s i , s e d a n g k a n p e r o m b a k a n d i t e n t u k a n o l e h

a k t i v i t a s o s t e o k l a s .

T a h a p a w a l p r o d u k s i t u l a n g a d a l a h s e k r e s i m o l e k u l k o l a g e n y a n g d i s e b u t

m o n o m e r k o l a g e n d a n s u b s t a n s i d a s a r ( t e r u t a m a p r o t e o g l i k a n ) o l e h o s t e o b l a s .

M o n o m e r k o l a g e n b e r p o l i m e r i s a s i d e n g a n c e p a t u n t u k m e m b e n t u k s e r a t k o l a g e n ;

j a r i n g a n y a n g d i h a s i l k a n n y a y a i t u o s t e o i d . S a a t o s t e o i d d i b e n t u k , s e j u m l a h

o s t e o b l a s t e r p e r a n g k a p d a l a m o s t e o i d d a n m e n j a d i i n a k t i f . P a d a t a h a p i n i ,

o s t e o b l a s d i s e b u t o s t e o s i t . B e b e r a p a h a r i s e t e l a h o s t e o i d d i b e n t u k , g a r a m k a l s i u m

m u l a i m e n g a l a m i p r e s i p i t a s i p a d a p e r m u k a a n s e r a t k o l a g e n , k e m u d i a n d e n g a n

c e p a t m e l a k u k a n m u l t i p l i k a s i m e n j a d i k r i s t a l h i d r o k s i a p a t i t ( C a H P O 4 ) . P r o s e s i n i

d i s e b u t d e n g a n m i n e r a l i s a s i , d i m a n a d i h a s i l k a n h i d r o k s i a p a t i t y a n g m e n y u s u n

9 5 % m i n e r a l t u l a n g y a n g k o m p o n e n t e r b e s a r n y a a d a l a h k a l s i u m ( G u y t o n , 2 0 0 0 ;

Y u l i a t i , 2 0 0 7 ) .

P e m b e n t u k a n t u l a n g d i m u l a i s a a t b a y i s a m p a i m e n c a p a i p u n c a k n y a s a a t

m e m a s u k i u s i a d e w a s a . H a l i n i d i t e n t u k a n o l e h f a k t o r g e n e t i k , n u t r i s i , k e g i a t a n

f i s i k , d a n p e n y a k i t . S e m a k i n t i n g g i n i l a i m a s s a t u l a n g m a k a a k a n s e m a k i n b a i k

y a i t u s e t e l a h p u n c a k m a s s a t u l a n g d i c a p a i p a d a u s i a 2 0 - 3 0 t a h u n . P a d a g a m b a r a n

k u r v a m a k a a k a n t e r l i h a t m e n d a t a r d a n k e m u d i a n s e k i t a r u s i a 4 0 t a h u n k u r v a

m u l a i m e n u r u n d e n g a n k e c e p a t a n ( l a j u ) p e n u r u n a n s e k i t a r 1 % p e r t a h u n

( M o r a w a t i , 2 0 0 9 ; G a f n i , 2 0 0 7 ) .

P e m b e n t u k a n d a n p e r o m b a k a n t u l a n g y a n g t e r j a d i s e c a r a k o n t i n u , d i s e b u t

d e n g a n p r o s e s r e m o d e l i n g . R e m o d e l i n g b e r t u j u a n u n t u k : 1 ) m e n j a g a t u l a n g a g a r

d a p a t d i g u n a k a n u n t u k k e p e r l u a n m e k a n i s d e n g a n k e e f e k t i f a n m a k s i m u m . T u l a n g

a k a n m e n y e s u a i k a n k e k u a t a n n y a a g a r s e b a n d i n g d e n g a n d e r a j a t t e k a n a n y a n g

d i t e r i m a n y a , s e h i n g g a t u l a n g a k a n m e n e b a l j i k a m e n e r i m a b e b a n b e r a t ; 2 )

9

m e m b a n t u m e m p e r t a h a n k a n k a d a r k a l s i u m p l a s m a , d a n 3 ) m e l a k u k a n p r o s e s

d e g e n e r a s i d i m a n a t u l a n g y a n g t u a ( s u d a h l e m a h d a n r a p u h ) a k a n d i g a n t i k a n

d e n g a n t u l a n g y a n g b a r u y a n g l e b i h k u a t ( B o u a s s i d a e t a l . , 2 0 0 6 ; C o r w i n , 2 0 0 8 ;

G u y t o n , 2 0 0 0 ) . P r o s e s r e m o d e l i n g i n i m e l a l u i 2 t a h a p , y a i t u t a h a p p e m b e n t u k a n

t u l a n g d a n t a h a p p e n g e r u s a k a n t u l a n g . P r o s e s p e m b e n t u k a n t u l a n g d i l a k u k a n o l e h

o s t e o b l a s s e b a g a i s e l u t a m a p e n g h a s i l m a t r i k s t u l a n g . O s t e o b l a s m e r u p a k a n s a l a h

s a t u j e n i s h a s i l d i f e r e n s i a s i s e l m e s e n k i m y a n g s a n g a t p e n t i n g d a l a m p r o s e s

o s i f i k a s i . O s t e o b l a s d i j u m p a i p a d a p e r m u k a a n l u a r t u l a n g d a n d i r o n g g a - r o n g g a

t u l a n g . O s t e o b l a s d a p a t m e m p r o d u k s i s u b s t a n s i o r g a n i k i n t r a s e l u l e r a t a u y a n g

d i s e b u t m a t r i k s . A p a b i l a k a l s i f i k a s i t e r j a d i p a d a m a t r i k s m a k a j a r i n g a n d i s e b u t

t u l a n g , t e t a p i a p a b i l a j a r i n g a n t i d a k m e n g a n d u n g k a l s i u m ( t i d a k t e r j a d i k a l s i f i k a s i )

m a k a d i s e b u t o s t e o i d . O s t e o b l a s b e r p e r a n d a l a m s i n t e s i s k o l a g e n u n t u k

m e m b e n t u k m a t r i k s t u l a n g j u g a m e n g a t u r k o n s e n t r a s i i o n k a l s i u m p a d a m a t r i k s

t u l a n g m e l a l u i p e l e p a s a n k a l s i u m d a r i i n t r a s e l u l e r ( C o r w i n , 2 0 0 8 ; R a s j a d , 2 0 0 7 ) .

O s t e o k l a s m e r u p a k a n s e l f a g o s i t i k y a n g b e r u k u r a n b e s a r d a n b e r i n t i b a n y a k ( 5 0

i n t i ) y a n g m e l a k u k a n p r o s e s r e s o r b s i a t a u p e n y e r a p a n t u l a n g s e c a r a k o n t i n u .

O s t e o k l a s p a d a k e a d a a n n o r m a l b e k e r j a a k t i f d i d a e r a h p e r m u k a a n t u l a n g .

O s t e o k l a s m e n g e l u a r k a n t o n j o l a n n y a y a n g m e n y e r u p a i v i l i k e a r a h t u l a n g , y a n g

m e m b e n t u k s u a t u p e r m u k a a n b e r g e l o m b a n g y a n g b e r d e k a t a n d e n g a n t u l a n g . V i l i

m e n g s e k r e s i k a n z a t ( 1 ) e n z i m p r o t e o l i t i k , y a n g d i l e p a s k a n d a r i l i s o s o m d a n ( 2 )

a s a m l a k t a t d a n a s a m s i t r a t y a n g d i l e p a s k a n d a r i m i t o k o n d r i a d a n v e s i k e l

s e k r e t o r i s . E n z i m p r o t e o l i t i k t e r s e b u t l a h y a n g a k a n m e m e c a h k a n m a t r i k s d a n

b e b e r a p a a s a m y a n g m e l a r u t k a n m i n e r a l t u l a n g , s e h i n g g a m i n e r a l t u l a n g s e p e r t i

k a l s i u m d a n f o s f a t t e r l e p a s k e d a l a m a l i r a n d a r a h ( G u y t o n , 2 0 0 0 ; C a r t e r . , 1 9 9 2 ) .

T e r j a d i n y a p e n i n g k a t a n a t a u k e h i l a n g a n m a s s a t u l a n g b e r g a n t u n g k e p a d a

k e s e i m b a n g a n k e d u a p r o s e s t e r s e b u t . H o r m o n s a n g a t b e r p e n g a r u h d a l a m p r o s e s

p e m b e n t u k a n t u l a n g , d i a n t a r a n y a a d a l a h h o r m o n e s t r o g e n , t e s t o s t e r o n , d a n

h o r m o n p e r t u m b u h a n y a n g a k a n m e n i n g k a t k a n a k t i f i t a s o s t e o b l a s d a n

p e r t u m b u h a n t u l a n g .

P e r t u m b u h a n t u l a n g d i p e r c e p a t s e l a m a m a s a p u b e r t a s ( m a s a p e r t u m b u h a n )

d i m a n a k a d a r h o r m o n p a d a m a s a t e r s e b u t m e l o n j a k . O l e h k a r e n a i t u d i h a r a p k a n

1 0

p e r t u m b u h a n t u l a n g d a p a t t e r j a d i d e n g a n b a i k s e l a m a m a s a p e r t u m b u h a n . A p a b i l a

u s i a t e l a h l a n j u t d a n t e l a h t e r j a d i m e n o p a u s e m a k a k a d a r h o r m o n e s t r o g e n t u r u n ,

h o r m o n p e r t u m b u h a n j u g a b e r k u r a n g s e h i n g g a a k t i f i t a s o s t e o b l a s m e n j a d i

b e r k u r a n g , y a n g m e n g a k i b a t k a n p e m b e n t u k a n t u l a n g b e r k u r a n g ( G u y t o n , 2 0 0 0 ;

M i l e s , 2 0 0 4 ; C o r w i n , 2 0 0 8 ) .

2 . 2 D e f i n i s i O s t e o s a r c o m a

O s t e o s a r c o m a a t a u d i s e b u t j u g a o s t e o g e n i k s a r k o m a a d a l a h t u m o r

m a l i g n a y a n g b e r a d a p a d a t u l a n g d a n m e r u p a k a n t u m o r t u l a n g p r i m e r m a l i g n a

y a n g p a l i n g s e r i n g d a n p a l i n g f a t a l . O s t e o s a r k o m a a t a u o s t e o g e n i k s a r k o m a i n i

d i p e r g u n a k a n b u k a n k a r e n a t u m o r m e m b e n t u k t u l a n g , t e t a p i k a r e n a p e m b e n t u k a n

t u m o r i n i b e r a s a l d a r i s e l o s t e o b l a s t i k d a r i s e l - s e l m e s e n k i n p r i m i t i f . T u m o r i n i

m e r u p a k a n t u m o r y a n g s a n g a t g a n a s , m e n y e b a r s e c a r a c e p a t p a d a p e r i o s t e u m d a n

j a r i n g a n i k a t d i l u a r n y a ( Z a i n i r , 2 0 1 3 ) .

O s t e o s a r c o m a a t a u s a r c o m a o s t e o g e n i k a d a l a h s u a t u p e r t u m b u h a n y a n g

c e p a t p a d a t u m o r m a l i g n a t u l a n g ( k a n k e r t u l a n g y a n g t i d a k d i k e t a h u i

p e n y e b a b n y a ) . K e g a n a s a n s e l p a d a m u l a n y a b e r l o k a s i p a d a s u m s u m t u l a n g

( m y e l o m a ) d a r i j a r i n g a n s e l t u l a n g ( s a r c o m a ) . P a d a t a h a p l e b i h l a n j u t , s e l - s e l

t u l a n g a k a n b e r a d a p a d a n o d u l - n o d u l l i m f a , h a t i , s e r t a l i m f a d a n g i n j a l a k i b a t

a d a n y a p e n g a r u h a k t i v i t a s h e m a t o p o i e t i c s u m s u m t u l a n g y a n g c e p a t p a d a t u l a n g ,

s e l - s e l p l a s m a y a n g b e l u m a t a u t i d a k m a t a n g a k a n t e r u s m e m b e l a h . A k i b a t n y a

t e r j a d i p e n a m b a h a n j u m l a h s e l y a n g t i d a k t e r k o n t r o l l a g i . S a r c o m a o s t e o g e n i k

s e r i n g t e r d a p a t p a d a p r i a d e n g a n u s i a 1 0 - 2 5 t a h u n , t e r u t a m a p a d a p a s i e n y a n g

m e n d e r i t a p e n y a k i t P a g e t . P e n y a k i t p a g e t a d a l a h g a n g g u a n p a d a t u l a n g y a n g

b e r s i f a t k r o n i k d e n g a n p e n y e m b u h a n y a n g t i d a k p a s t i ( S u r a t u n , 2 0 0 8 )

2 . 3 E t i o l o g i O s t e o s a r c o m a

P e n y e b a b o s t e o s a r k o m a m a s i h b e l u m j e l a s d i k e t a h u i . A d a n y a h u b u n g a n

k e k e l u a r g a a n m e n j a d i s u a t u p r e d i s p o s i s i , b e g i t u p u l a a d a n y a h e r e d i t e r y

r e t i n o b l a s t o m a . R a d i a s i i o n d i k a t a k a n m e n j a d i 3 % p e n y e b a b l a n g s u n g

1 1

o s t e o s a r k o m a . D u a t u m o r s u p p r e s s o r g e n e y a n g b e r p e r a n s e c a r a s i g n i f i k a n

t e r h a d a p t u m o r i g e n e s i s p a d a o s t e o s a r k o m a , y a i t u p r o t e i n p 5 3 ( k r o m o s o m 1 7 ) d a n

R b ( k r o m o s o m 1 3 ) ( Z a i n i r , 2 0 1 3 ) .

A d a p u n f a k t o r p r e d i p o s i s i y a n g d a p a t m e n y e b a b k a n o s t e o s a r c o m a a n t a r a

l a i n :

1 . T r a u m a

O s t e o s a r c o m a d a p a t t e r j a d i p a d a b e b e r a p a b u l a n a t a u b e b e r a p a t a h u n s e t e l a h

t e r j a d i i n j u r y . W a l a u p u n d e m i k i a n t r a u m a i n i t i d a k d a p a t l a n g s u n g d i a n g g a p

s e b a g a i p e n y e b a b u t a m a k a r e n a t u l a n g y a n g f r a k t u r a k i b a t t r a u m a r i n g a n

m a u p u n p a r a h j a r a n g m e n y e b a b k a n o s t e o s a r c o m a .

2 . E k s t r i n s i k k a r s i n o g e n

P e n g g u n a a n s u b s t r a n s i r a d i o a k t i f d a l a m j a n g k a w a k t u l a m a d a n m e l e b i h i

d o s i s j u g a d i d u g a m e r u p a k a n p e n y e b a b t e r j a d i n y a o s t e o s a r c o m a i n i . S a l a h

s a t u c o n t o h a d a l a h r a d i a s i , r a d i a s i y a n g d i b e r i k a n u n t u k p e n y a k i t t u l a n g

s e p e r t i k i s t a t u l a n g a n e r i s m a l , f i b r o u s d i s p l a s i a , s e t e l a h 3 - 4 0 t a h u n d a p a t

m e n g a k i b a t k a n o s t e o s a r c o m a .

3 . K a r s i n o g e n i k k i m i a

A d a d u g a a n d e n g a n p e n g g u n a a n t h o r i u m u n t u k p e n d e r i t a t u b e r c u l o s i s

m e n g a k i b a t k a n 1 4 d a r i 5 3 p a s i e n b e r k e m b a n g m e n j a d i o s t e o s a r c o m a .

4 . V i r u s

P e n e l i t i a n t e n t a n g v i r u s y a n g d a p a t m e n y e b a b k a n o s t e o s a r c o m a b a r u

d i l a k u k a n p a d a h e w a n , s e d a n g k a n s e j u m l a h u s a h a u n t u k m e n e m u k a n

o n c o g e n i k v i r u s p a d a o s t e o s a r c o m a m a n u s i a t i d a k b e r h a s i l . W a l a u p u n

b e b e r a p a l a p o r a n m e n y a t a k a n a d a n y a p a r t i k e l s e p e r t i v i r u s p a d a s e l

o s t e o s a r c o m a d a l a m k u l t u r j a r i n g a n .

P a d a t u m o r m u s k u l o s k e l t a l s i s t e m s t a g i n g m e n g g u n a k a n M u s c u l o s k e l e t a l

T u m o r S o c i r t y , b e g i t u j u g a p a d a o s t e o s a r c o m a . S t a g i n g i n i b e r d a s a r k a n g r a d i a s i

h i s t o l o g i s d a r i t u m o r ( i n t r a k o m p a r t m e n t a l a t a u e k s t r a k o m p a r m e n t a l ) , d a n a d a

t i d a k n y a m e t a s t a s e ( S i k i , 2 0 0 9 ) . S e s u a i d e n g a n E n n e k i n g S y s t e m , m a k a t i n g k a t a n

d a r i o s t e o s a r k o m a a d a l a h s e b a g a i b e r i k u t

1 2

1 . S t a d i u m t u m o r r e n d a h , i n t r a c o m p a r t m e n t a l - I - A

2 . S t a d i u m t u m o r r e n d a h , e x t r a c o m p a r t m e n t a l - I - B

3 . S t a d i u m t u m o r t i n g g i , i n t r a c o m p a r t m e n t a l - I I - A

4 . S t a d i u m t u m o r t i n g g i , e x t r a c o m p a r t m e n t a l - I I - B

5 . T u m o r d e n g a n m e t a s t a s i s - I I I

S t a g i n g s y s t e m i n i s a n g a t b e r g u n a d a l a m p e r e n c a n a a n s t r a t e g i , p e r e n c a n a a n

p e n g o b a t a n , d a n m e m p e r k i r a k a n p r o g n o s i s d a r i o s t e o s a r k o m a t e r s e b u t .

2 . 4 M a n i f e s t a s i K l i n i s

O s t e o s a r c o m a l e b i h s e r i n g d i t e m u k a n p a d a l a k i - l a k i , t i m b u l p a d a d e k a d e

k e d u a , y a i t u a n t a r a u m u r 5 - 3 0 t a h u n , t e r b a n y a k p a d a u m u r 1 0 - 2 0 t a h u n . A k a n

t e t a p i b i s a j u g a p a d a a k h i r u s i a d e w a s a y a n g b e r h u b u n g a n d e n g a n p e n y a k i t P a g e t

( P a g e t s d i s e a s e ) ( S i k i , 2 0 0 9 ) . O s t e o s a r k o m a s e r i n g t e r d a p a t d i d a e r a h l u t u t p a d a

a n a k - a n a k d a n d e w a s a m u d a , t e r b a n y a k p a d a d i s t a l d a r i f e m u r . P a d a a n a m n e s i s ,

k e l u h a n u t a m a y a n g s e r i n g m u n c u l a d a l a h n y e r i , d e f o r m i t a s , d a n h a m b a t a n

m o b i l i t a s f i s i k . K o n d i s i d a r i k e l u h a n d i r a s a k a n s e c a r a p e r l a h a n - l a h a n d i s e r t a i

a d a n y a n y e r i p a d a s e k i t a r l e s i d a n k e s u l i t a n d a l a m m e n g g e r a k k a n e k s t r e m i t a s

y a n g t e r l i b a t . K e l u h a n b i a s a n y a s u d a h a d a 3 b u l a n s e b e l u m n y a d a n s e r i n g

d i h u b u n g k a n d e n g a n t r a u m a . T e r d a p a t b e n j o l a n p a d a d a e r a h d e k a t s e n d i y a n g

s e r i n g k a l i s a n g a t b e s a r , n y e r i t e k a n d a n t a m p a k p e l e b a r a n p e m b u l u h d a r a h p a d a

k u l i t d i p e r m u k a a n . T i d a k j a r a n g m e n i m b u l k a n e f u s i p a d a s e n d i y a n g b e r d e k a t a n .

S e r i n g j u g a d i t e m u k a n n a d a n y a p a t a h t u l a n g p a t o l o g i s ( Z a i n i r , 2 0 1 3 ) .

2 . 5 P a t o f i s i o l o g i O s t e o s a r c o m a

O s t e o s a r k o m a m e r u p a k a n t u m o r g a n a s p r i m e r y a n g p a l i n g s e r i n g d i j u m p a i .

U s i a t e r b a n y a k p a s i e n o s t e o s a r k o m a a d a l a h r e m a j a d e n g a n p u n c a k u s i a 1 5 - 1 9

t a h u n . P e n y e b a b t i m b u l n y a o s t e o s a r k o m a b e l u m d i k e t a h u i d e n g a n p a s t i . B e b e r a p a

f a k t o r y a n g d i d u g a s e b a g a i p e m i c u a d a l a h t r a u m a , i n f e k s i v i r u s , r a d i a s i , d a n

p a p a r a n z a t k i m i a a t a u a l k y l a t i n g a g e n t . S e l a i n i t u o s t e o s a r k o m a d a p a t d i j u m p a i

p a d a b e b e r a p a k e l a i n a n g e n e t i k s e p e r t i p e n y a k i t P a g e t d a n r e t i n o b l a s t o m a

1 3

h e r e d i t e r . P a d a b e b e r a p a o s t e o s a r k o m a d i j u m p a i p e n u r u n a n f u n g s i g e n s u p r e s o r

t u m o r y a i t u g e n p 5 3 d a n R B ( r e t i n o b l a s t o m a ) .

L o k a s i t u m o r s e r i n g d i j u m p a i p a d a d a e r a h f e m u r d i s t a l , t i b i a p r o k s i m a l ,

h u m e r u s p r o k s i m a l d a n f i b u l a p r o k s i m a l . O s t e o s a r k o m a p a d a t u l a n g r a n g k a

l a i n n y a a t a u t u l a n g - t u l a n g k r a n i o f a s i a l b i a s a n y a d i t e m u k a n p a d a p a s i e n l e b i h t u a .

S t e m s e l m e s e n k i m a l s e c a r a n o r m a l a k a n b e r d i f e r e n s i a s i m e n j a d i t u l a n g ,

k a r t i l a g o , o t o t , s u m s u m t u l a n g , t e n d o n , l i g a m e n d a n j a r i n g a n i k a t . P a d a

o s t e o s a r k o m a d i f e r e n s i a s i i n i m e n g a l a m i k e g a g a l a n , s e h i n g g a o s t e o p r o g e n i t o r

t i d a k b e r k e m b a n g m e n j a d i p r o o s t e o b l a s . S e l i m a t u r i n i b e r k e m b a n g t e r u s d a n s e l

t u m o r a k a n m e n e m b u s t r a b e k u l a t u l a n g , s y s t e m H a v e r s d a n k a n a l i s V o l k m a n n .

B i l a t u m o r t e l a h m e n c a p a i p e r m u k a a n k o r t e k s p a l i n g l u a r , p e r i o s t e u m t e r p u t u s

d a r i t u l a n g . L a p i s a n k a m b i u m d a l a m p e r i o s t e u m b e r e a k s i a g a r t e r p i s a h d a r i

k o r t e k s d e n g a n m e m b e n t u k t u l a n g b a r u y a n g k a d a n g - k a d a n g t e r l i h a t s e b a g a i k u l i t

t u l a n g i n k o m p l i t y a n g t a m p a k t e r k a i t d e n g a n p e r m u k a a n t u l a n g h a n y a p a d a s a t u

s i s i d a n t e r b u k a a t a u t e r p u t u s d i t e n g a h d i s e b u t s e g i t i g a C o d m a n .

2 . 6 P e m e r i k s a a n D i a g n o s t i k

P e m e r i k s a a n d i a g n o s t i k d i g u n a k a n u n t u k m e n e g a k k a n d i a g n o s i s d a r i s u a t u

m a s a l a h d a n d i g u n a k a n u n t u k m e l i h a t g a m b a r a n y a n g a d a d i d a l a m t u b u h ,

m i s a l n y a p a d a t u l a n g . B e b e r a p a c a r a m e n d i a g n o s i s s u a t u p e n y a k i t , y a i t u d e n g a n

m e l i h a t :

1 . R i w a y a t p e n y a k i t d a n c a r a - c a r a g e j a l a t e r s e b u t t i m b u l

2 . P e m e r i k s a a n n e u r o l o g i s m e n u n j u k k a n a r e a y a n g t e r l i b a t

3 . P e m i n d a i a n C T , M R I , b i o p s y s t e r e o s t a t i k d e n g a n b a n t u a n k o m p u t e r

( g a m b a r a n 3 d i m e n s i ) , a n g i o g r a f i s e r e b r a l , e l e k t r o e n s e f a l o g r a f i , d a n

p e m e r i k s a a n s i t o l o g y c a i r a n s p i n a l s e r e b r a l .

1 4

a . C T ( C o m p u t e r T o m o g r a p h y )

C o m p u t e r T o m o g r a f i m e r u p a k a n p e m e r i k s a a n d e n g a n d o s i s r a d i a s i

y a n g t i n g g i , d i m a n a s e h a r u s n y a d i s e s u a i k a n d e n g a n k e b u t u h a n k l i n i s . C T

p a d a l e s i t u l a n g m e n y e d i a k a n i n f o r m a s i m e n g e n a i m i n e r a l i s a s i t u m o r y a n g

s u l i t d i d a p a t k a n p a d a f o t o p o l o s . C T n o n k o n t r a s p a d a t h o r a k s t e p a t

d i g u n a k a n u n t u k m e n e n t u k a n s t a d i u m m e t a s t a s e o s t e o s a r c o m a . C T p a d a

p a s i e n t u a s e h a r u s n y a m e m p e r t i m b a n g k a n i n d e k s l e s i t u l a n g y a n g

m e n g a l a m i m e t a s t a s i s . C T d e n g a n f l u o r o s c o p i m e r u p a k a n p r o s e d u r b i o p s y

y a n g i d e a l d a n m e r u p a k a n p r o s e d u r i n t e r v e n s i o n a l . L a n g k a h u n t u k

m e m i n i m a l k a n d o s i s r a d i a s i s a n g a t p e n t i n g b a g i p a s i e n d a n o p e r a t o r .

S o l u s i n y a a d a l a h p o s i s i p a s i e n d a p a t m e n g h a s i l k a n g a m b a r d e n g a n k u a l i t a s

t i n g g i s e s u a i d e n g a n c a b a n g d a r i l e s i o s t e o s a r c o m a ( t i d a k p e r l u d e n g a n

m e m i n d a h k a n b a g i a n p a s i e n d a r i p a p a n p e n y i n a r a n ) .

P e n y i n a r a n u t a m a p a d a k a n k e r p a l i n g t e p a t d i l a k u k a n k e t i k a t i d a k a d a

k o n t r a i n d i k a s i a t a u f o t o p o l o s t i d a k a d e k u a t d a l a m m e n e n t u k a n d i a g n o s i s

m i s a l n y a p a d a t u l a n g b e a k a n g , p e l v i s d a n t u l a n g r u s u k . K e s e l u r u h a n

p e n g k a j i a n d a p a t m e n i l a i d i m a n a l e s i t u l a n g d i c u r i g a i t e r j a d i m e t a s t a s i s .

G a m b a r 1 . H a s i l C T O s t e o s a r c o m a p a d a t u l a n g r u s u k

s e t e l a h 2 0 t a h u n m e n j a l a n i m a s t e c t o m y d a n r a d i o t e r a p i

u n t u k k a r s i n o m a p a y u d a r a . T e r l i h a t m i n e r a l i s a s i m a t r i x

d a r i t u m o r

1 5

b . M R I

M R I m a g i n g a d a l a h a l a t y a n g m a m p u m e n d e t e k s i , m e n d i a g n o s i s ,

m e n e n t u k a n s t a d i u m d a n d a p a t m e n i n d a k l a n j u t i k a n k e r t u l a n g . I m a g i n g

d i h a s i l k a n d e n g a n l a p a n g y a n g k e c i l d a n d i g a m b a r k a n u n t u k

m e m a k s i m a l k a n d e t a i l d a r i h a s i l g a m b a r . T 1 m e r u p a k a n p a r t i k e l p e n t i n g

d a l a m e v a l u a s i s u m s u m t u l a n g , d i m a n a s e h a r u s n y a p e n y i n a r a n t r a n s p a r a n

d i h i n d a r i . T e k a n a n l e m a k h a r u s d i t a m b a h k a n k e t i k a m e m p e r o l e h h a s i l d a r i

T 2 u n t u k m e l i h a t k a n k e r y a n g d i k e l i l i n g i s u m s u m t u l a n g d a n e d e m a . M R I

m e n y e d i a k a n i n f o r m a s i y a n g b e r g u n a u n t u k m e n e n t u k a n k a r a k t e r i s t i k l e s i

t u l a n g , a k i b a t n y a d i d a p a t k a n r e s p o n k e t i k a p e n g k a j i a n u n t u k t e r a p i d a n

m e n d e t e k s i k a n k e r y a n g b e r u l a n g .

1 6

c . N u k l e a r m e d i c i n e

T e k n i k p e n y i n a r a n d e n g a n m e t i l i u m d i p o s p a t ( T c - M D P ) :

a . M e n d e t e k s i m e t a b o l i s m e t u l a n g

b . P e n y i n a r a n n o n s p e s i f i k

c . M e n b u a t d u g a a n p r i m e r p a d a e v a l u a s i k e g a n a s a n t u l a n g

d . D a p a t m e n u n j u k k a n p o l a p e n y a k i t a t a u d i s t r i b u s i p e n y a k i t u n t u k

m e n e g a k k a n d i a g n o s i s

d . P o s i t r o n E m i s i o n T o m o g r a f i ( P E T ) d i k o m b i n a s i k a n d e n g a n C o m p u t e r

T o m o g r a f i ( C T ) :

1 . M e n d e f i n i s i k a n p e r a n a n p a d a m a n a j e m e n o s t e o s a r c o m a

2 . L e s i p r i m e r d a r i p e n y i n a r a n m e n g g u n a k a n f l o r o - 2 - d e o x y - d - g l u c o s e

( F D G ) a t a u r a d i o f a r m a k a y a n g l a i n u n t u k a p l i k a s i p e n y e m b u h a n .

3 . P e n g e t a h u a n y a n g t e r b a t a s d a n p r o s e d u r n o r m a l p a d a p e r i n t a h u n t u k

m e n g h i n d a r i h a s i l p o s i t i f p a l s u .

4 . W a k t u t u n d a y a n g c u k u p d i p e r l u k a n p a d a p e n y i n a r a n d a n s e b e l u m

p e m b e d a h a n a t a u r a d i o t e r a p i u n t u k m e m b e d a k a n k e j a d i a n b e r u l a n g d a n

r e a k s i i n f l a m a s i .

5 . D a p a t m e n d i s k r i p s i k a n r e s p o n d a r i t e r a p i d a n s e b a g a i i n d i k a t o r p r o g n o s i s

p a d a m a n j e m e n o s t e o s a r c o m a .

1 7

2 . 7 P e n a t a l a k s a n a a n O s t e o s a r c o m a

T u j u a n p e n a t a l a k s a n a a n y a n g d a p a t d i l a k u k a n a d a l a h m e n g h a n c u r k a n a t a u

m e n g a n g k a t j a r i n g a n g a n a s d e n g a n m e t o d e s e e f e k t i f m u n g k i n . T i n d a k a n

p e n g a n g k a t a n t u m o r b i a s a n y a d e n g a n a m p u t a s i . K e m o t e r a p i u n t u k m e n g u r a n g i

m a s a t u m o r d e n g a n a g e n p e n g e l a t k e m o t e r a p i y a n g d i k o m b i n a s i k a n d a n

d i l a k s a n a k a n s e b e l u m d a n s e t e l a h p e m b e d a h a n u n t u k m e m b a s m i l e s i

m i k r o m e t a s t a t i k . S e l a i n i t u , k l i e n d i b e r i k a n a n a l g e s i k d a n n a r k o t i k , s e r t a

a l o p u r i n o l u n t u k m e n g o n t o l h i p e r u r i s e m i a . H a l u a a n u r i n e h a r u s b a i k ( 2 5 0 0 - 3 0 0 0

m l / h a r i ) u n t u k m e n g u k u r k a d a r k a l s i u m s e r u m s e r t a m e n c e g a h h i p e r k a l s i u m d a n

h i p e r u r i s e m i a ( S u r a t u n 2 0 0 8 ) .

P e n a t a l a k s a n a a n M e d i s m e n u r u t S u s a n M e r t i n , 1 9 9 8 a d a l a h :

1 . B i o p s i , a m p u t a s i

2 . A g e n a n t i c o p l a s m a

1 8

3 . T e r a p i r a d i a s i

4 . A n a l g e s i k , t r a n q u i l i z e r

5 . D i e t , a k t i v i t a s , i m o b i l i s a s i a n g g o t a t u b u h

P e n a t a l a k s a n a a n m e n u r u t Z a i r i n N o o r , 2 0 1 3 a d a l a h :

1 . K o n s e r v a t i f .

P e n a n g a n a n k a n k e r t u l a n g m a t a s t a s i s a d a l a h p a l i a t i f , d a n s a s a r a n

t e r a u p e t i k n y a a d a l a h m e n g u r a n g i n y e r i d a n k e t i d a k n y a m a n a n k l i e n

s e b a n y a k m u n g k i n . T e r a p i t a m b a h a n d i s e s u a i k a n d e n g a n m e t o d e y a n g

d i g u n a k a n u n t u k m e n a n g a n i k a n k e r a s a l . F i k s a s i i n t e r n a f r a k t u r p a t o l o g i

d a p a t m e n g u r a n g i k e c a c a t a n d a n n y e r i y a n g t i m b u l . B i l a p e r l u , t u l a n g b e s a r

d e n g a n l e s i m e t a s t a s i s d a p a t d i p e r k u a t d e n g a n f i k s a s i i n t e r n a p r o f i l a k s i s .

P e m b e d a h a n d a p a t d i i n d i k a s i k a n p a d a f r a k t u r t u l a n g p a n j a n g . B i l a t e r d a p a t

h i p e r k a l s e m i a , p e n a n g a n y a n g d i l a k u k a n m e l i p u t i h i d r a s i d e n g a n p e m b e r i a n

c a i r a n s a l i n n o r m a l i n t r a v e n a , d i u r e t i k a , m o b i l i s a s i , d a n o b a t - o b a t a n s e p e r t i

f o s f a t , m i t r a m i s i n , k a l s i t o n i n , a t a u k o r t i k o s t e r o i d .

2 . K e m o t e r a p i .

K e m o t e r a p i m e r u p a k a n s u a t u p e n a t a l a k s a n a a n t a m b a h a n p a d a t u m o r g a n a s

t u l a n g d a n j a r i n g a n l u n a k . O b a t - o b a t a n y a n g d i p e r g u n a k a n a d a l a h

m e t r o t r e k s a t , a d r i a m i s i n , s i k l o f o s f a m i d , v i n k r i s t r i n , d a n s i s p l a t i n u m .

P e m b e r i a n k e m o t e r a p i b i a s a n y a d i l a k u k a n p a d a p r e / p a s c a o p e r a s i .

3 . R a d i o t e r a p i .

R a d i a s i d e n g a n e n e r g i t i n g g i m e r u p a k a n s u a t u c a r a u n t u k e r a d i k a s i t u m o r -

t u m o r g a n a s y a n g r a d i o s e n s i t i f d a n d a p a t j u g a s e b a g a i p e n a t a k s a a n a w a l

s e b e l u m t i n d a k a n o p r a s i d i l a k u k a n . K o m b i n a s i r a d i o t e r a p i d a p a t p u l a

d i b e r i k a n b e r s a m a - s a m a k e m o t e r a p i . R a d i o t e r a p i d i l a k u k a n p a d a k e a d a a n -

k e a d a a n y a n g d a p a t d i o p r a s i , m i s a l n y a a d a n y a m e t a s t a s i s a t a u k e a d a a n l o k a l

y a n g t i d a k m e m u n g k i n k a n u n t u k t i n d a k a n o p r a s i .

4 . I n t e r v e n s i b e d a h .

O l e h k a r e n a a d a n y a b a h a y a m e t a s t a s i s p a d a t u m o r m a l i g n a , m a k a

k o m b i n a s i k e m o t e r a p i d i m u l a i s e b e l u m d a n d i l a n j u t k a n s e t e l a h p e m b e d a h a n

1 9

s e b a g a i u s a h a m e n g e r a d i k s i l e s i m i k r o m e t a s t a s i s . H a r a p a n n y a a d a l a h

k o m b i n a s i k e m o t e r a p i m e m p u n y a e f e k y a n g l e b i h t i n g g i d e n g a n t i n g k a t

t o k s i s i t a s y a n g r e n d a h s a m b i l m e n u r u n k a n k e m u n g k i n a n r e s i s t e n s i t e r h a d a p

o b a t .

5 . O p e r a s i r a d i k a l .

O p e r a s i r a d i k a l d i l a k u k a n s e p e r t i p a d a e k s i s i l u a s d a n d i t a m b a h d e n g a n

p e n g e l u a r a n s e l u r u h t u l a n g , s e r t a s e n d i d a n j a r i n g a n s e b a g a i s a t u b a g i a n

y a n g u t u h . C a r a i n i b i a s a n y a b e r u p a a m p u t a s i a n g g o t a g e r a k d i a t a s n y a d a n

d i s e r t a i p e n g e l u a r a n s e n d i d i a t a s n y a .

2 . 8 K o m p l i k a s i

A p a b i l a t u m o r t e l a h b e r m e t a s t a s e ( m e n y e b a r ) , m a k a a k a n d a p a t m e n y e r a n g

o r g a n t u b u h s e k i t a r s e h i n g g a a k a n t e r j a d i k e a b n o r m a l a n f u n g s i s e l u r u h o r g a n .

B a g i t u m o r g a n a s , a k a n d a p a t m e n g a k i b a t k a n k e m a t i a n y a n g d i k a r e n a k a n

m e r u s a k s e m u a s e l o r g a n t u b u h .

2 . 9 P r o g n o s i s

P a d a a w a l p e r t a m a d i t e m u k a n , p r o g n o s i s O s t e o s a r k o m a s a n g a t b u r u k , 5

y e a r s S u r v i v a l R a t e h a n y a b e r k i s a r a n t a r a 1 0 - 2 0 % . N a m u n d e n g a n t e r a p i a d j u v a n

b e r u p a s i t o s t a t i k y a n g a g r e s i f d a n i n t e n s i f y a n g d i b e r i k a n p r a b e d a h d a n p a s c a

b e d a h , S u r v i v a l R a t e m e n j a d i l e b i h b a i k d a p a t m e n c a p a i 6 0 - 7 0 % . T e r a p i a d j u v a n

y a n g m u l a i d i t e r a p k a n m e m b u a t a m p u t a s i s e b a g a i i s a l a h s a t u t i n d a k a n t e r a p i

m e n j a d i b e r k u r a n g .

20

2.10 Web of Causation

Osteolitik

Penghancuran tulang lokal

Pe pemecahan & pengangkutan Ca

Osteoponia

Osteoporosis

Mudah fraktur

MK: Resiko Cidera

Inflamasi

Pembengkakan sel tulang

Aktivasi reseptor nyeri

Aktivasi bradikinin dan prostaglandin

MK: Nyeri kronis

Osteoblastik

Sel imatur berkembang terus

Sel tumor menembus trabekula tulang, sistem havers & kanalis volkman

Sel tumor menyebar Menekan

pembuluh darah di sekitar tulang

PK: Pendarahan

Trauma, infeksi virus, radiasi, paparan zak kimia/ Alkalyting agent, genetik

Gen defect

Mutasi DNA

Aktivasi Onkogen

Keganasan

OSTEOSARCOMA

Pemeriksaan diagnostik

MK: Ansietas

Kurang Pengetahuan

Osteoprogenitos tidak menjadi peosteoblast

21

Pembengkakan sel tulang

Kerusakan struktur tulang

Aktivasi reseptor nyeri

Aktivasi bradykinin dan prostaglandin

MK: Nyeri kronis

Tulang lebih rapuh

Resiko fraktur

MK: Resiko cidera

MK: Hambatan

mobilitas fisik

Depresi saraf otonom pada

sistem pencernanaan

Mual, muntah

Kehilangan nafsu makan

MK: Ketidak seimbangan nutrisi

kurang dari kebutuhan tubuh

Sekresi enzim untuk lapisan osteoid

superfisial

Proses reabsorbsi tulang oleh

osteoklas terganggu

Ca terserap darah dalam jumlah besar

PK: Hiperkalsemi

Hiperkalsemia pada darah

Defisit tubular ginjal

Pe pembentukan

urine

Poliuria

Cairan tubuh berkurang

Dehidrasi

MK: Kekurangan volume cairan

Tumor sampai ke sel spinal

Spinal lession

Neurologic manifestation

Nyeri skoliosis

Defisit neurologis

Kebingungan, gangguan emosi,

halusinasi, kesadaran

Menekan sel tulang

Produksi darah

RBC

HB

O2

Tubuh melakukan kompensasi

dengan mengikat banyak O2

Hiperventilasi

MK: Ketidakefektifan

pola napas

MK: Ketidakefektifan perfusi jaringan

Perfusi jaringan

Aliran darah

22

Tindakan bedah/ operasi

Eksisi tumor, jaringan dan tulang di sekitarnya

MK: Nyeri

Bone Graft

Kegagalan resorbsi tulang

Revaskularisasi inadekuat

Kadar kalsium tulang

Pemenuhan nutrisi tulang inadekuat

Pertumbuhan tulang baru tidak terjadi

Penatalaksanaan

Eksisi

Luas

Tumor dikeluarkan secara utuh disertai

jaringan

Kombinasi pemberian kemoteraapi/ radioterapi

pra/ pasca operasi)

Kelemahan sistem imun

Rambut rontok, turgor kulit kurang

Eksisi luas ditambah pengeluaran seluruh tulang, sendi, dan jaringan sebagai

bagian utuh (amputasi)

Kehilangan anggota gerak

Perubahan bentuk tubuh

MK: Gangguan citra tubuh

MK: Harga diri rendah

Kemoterapi

Alopesia

Kulit kering

Diare

Mual muntah

MK: Ketidak seibmangan

nutrisi kurang dari kebutuhan

tubuh

MK: Ketidak seimbangan

cairan kurang dari kebutuhan

tubuh

MK: Kerusakan integritas

kulit

Kerusakan sel rambut

Operasi radikal

2 3

B A B 3

A S U H A N K E P E R A W A T A N O S T E O S A R K O M A

3 . 1 P e n g k a j i a n

a . D a t a d e m o g r a f i : n a m a , u s i a , j e n i s k e l a m i n , t e m p a t t i n g g a l , d i a g n o s a m a s u k ,

p e k e r j a a n , d a n s e b a g a i n y a .

b . K e l u h a n u t a m a : k e l u h a n u t a m a y a n g b i a s a n y a d i r a s a k a n o l e h p a s i e n d e n g a n

o s t e o s a r c o m a b e r u p a n y e r i s e r t a p e m b e n g k a k a n e k s t r e m i t a s y a n g t e r k e n a ,

b i a s a n y a m e n j a d i s e m a k i n p a r a h p a d a m a l a m h a r i d a n m e n i n g k a t s e s u a i d e n g a n

p r o g r e s i v i t a s p e n y a k i t , s e r i n g b e r k e r i n g a t p a d a m a l a m h a r i , n a f s u m a k a n

b e r k u r a n g d a n s a k i t k e p a l a .

c . R i w a y a t p e n y a k i t s e k a r a n g : k a j i n y e r i p a d a p a s i e n d e n g a n m e n g g u n a k a n

m e t o d e P Q R S T ( f a k t o r p r m i c u , k u a l i t a s n y a , d a e r a h , s k a l a d a n w a k t u . S e l a i n i t u

t a n d a d a n g e j a l a l a i n b e r u p a k e t e r b a t a s a n s e n d i d a l a m b e r g e r a k , a d a n y a

p e m b e n g k a k a n p a d a t u l a n g a t a u p e r s e n d i a n , s e r t a g e j a l a m e t a s a t a s e m e l i p u t i

n y e r i d a d a , b a t u k , d e m a m , p e n u r u n a n b e r a t b a d a n d a n m a l a i s e k a j i j u g a a p a

y a n g s u d a h d i l a k u k a n k l i e n u n t u k m e n g a t a s i k e l u h a n n y a y a n g b e r d a m p a k p a d a

a k t i f i t a s s e h a r i h a r i .

d . R i w a y a t p e n y a k i t d a h u l u : h a l y a n g p e r l u d i k a j i a p a k a h p a s i e n p e r n a h

m e n g a l a m i t r a u m a p a d a t u l a n g e k s t r e m i t a s , p e n y a k i t t u l a n g y a n g p e r n a h

d i r a s a k a n s e p e r t i p e n y a k i t p a g e t s e b a g a i a k i b a t d a r i p a p a r a n r a d i a s i y a n g t i n g g i .

e . R i w a y a t p e n y a k i t k e l u a r g a : K e m u n g k i n a n a d a s a l a h s e o r a n g k e l u a r g a y a n g

p e r n a h m e n d e r i t a k a n k e r .

f . G a y a h i d u p : k a j i a p a k a h p a s i e n p e r n a h m e n g a l a m i p a p a r a n r a d i a s i d e n g a n d o s i s

t i n g g i , m e n g o n s u m s i m a k a n a n y a n g m e n g a n d u n g z a t k a r s i n o g e n i k d a n j u g a

k e b i a s a a n l a i n y a n g k u r a n g b a i k t e r h a d a p k e s e h a t a n m i s a l n y a m e r o k o k .

2 4

3 . 1 . 1 P e m e r i k s a a n F i s i k ( R e v i e w o f S y s t e m )

a . B 1 ( B r e a t h i n g ) : b i a s a n y a j a r a n g d i t e m u k a n m a s a l a h k a r e n a s a r c o m a o s t e o g e n i k

b i a s a n y a t e r j a d i p a d a t u l a n g p a n j a n g k e c u a l i j i k a t e r j a d i m e t a s t a s i s k e p a r u - p a r u

m e l i p u t i n y e r i d a d a s e r t a b a t u k ( S m e l t z e r 2 0 0 1 )

b . B 2 ( B l o o d ) : C R T < 1 d e t i k d a n k e r i n g a t d i n g i n . K l i e n s e r i n g m e n g a l a m i

a n e m i a y a n g b e r h u b u n g a n d e n g a n p r o s e s p e n i n g k a t a n n e o v a s k u l a r i s a s i d a n

p e n i n g k a t a n k e b u t u h a n d a r a h u n t u k p e m b e n t u k a n j a r i n g a n b a r u .

c . B 3 ( B r a i n ) : c o m p o s m e n t i s

d . B 4 ( B l a d d e r ) : h i p e r k a l s e m i d a p a t m e n y e b a b k a n g a n g g u a n p a d a g i n j a l

e . B 5 ( B o w e l ) : m u a l - m u n t a h , p e n u r u n a n n a f s u m a k a n , B B t u r u n

f . B 6 ( B o n e ) :

1 ) L o o k ( t e r d a p a t m a s s a t u m o r , r a d a n g , d e f o r m i t a s d i d a e r a h t u l a n g f e m u r )

2 ) F e e l ( n y e r i t u m p u l p a d a t u l a n g f e m u r , t e r a b a h a n g a t )

3 ) M o v e ( p r o s e n t a s e k e m a m p u a n p a s i e n u n t u k m e l a k u k a n f l e k s i d a n e k s t e n s i

a d a k e l e m a h a n f i s i k , n y e r i s a a t g e r a k a k t i f d a n p a s i f )

3 . 1 . 2 P e m e r i k s a a n P e n u n j a n g

a . R a d i o l o g i : b i a s a n y a g a m b a r a n r a d i o g r a m d a p a t m e m b a n t u u n t u k m e n e n t u k a n

k e g a n a s a n r e l a t i v e d a r i t u m o r t u l a n g .

b . F o t o p o l o s t u l a n g : d a p a t m e n d e t e k s i a d a n y a l e s i s c l e r o s i s p a d a

k o r t e k s , a p a k a h t u m o r b e r s i f a t s o l i t e r a t a u m u l t i p l e s e r t a t u l a n g y a n g t e r k e n a .

c . C T s c a n : m e m b e r i k a n i n f o r m a s i t e n t a n g t u m o r d a n b i a s a n y a d i l a k u k a n p a d a

s p i n a a t a u k e p a l a f e m u r

d . B i o p s y : d i g u n a k a n u n t u k m e n e t a p k a n s t a d i u m t u m o r .

e . P e m e r i k s a a n f o t o t h o r a k s : d i l a k u k a n s e b a g a i p r o s e d u r r u t i n d a n u n t u k f o l l o w

u p a d a n y a m e t a s t a s e p a d a p a r u ( C h a i r u d d i n r a s j a d , 2 0 0 3 ) .

f . P e m e r i k s a a n d a r a h , b i a s a n y a m e n u n j u k k a n a d a n y a p e n i n g k a t a n a l k a l i n

f o s f a t a s e d a n j u g a h i p e r k a l s e m i .

g . P e m e r i k s a a n B G A b i s a d i l a k u k a n a p a b i l a d i c u r i g a i a d a n y a m e t a s t a s e s s e l

k a n k e r k e p a r u - p a r u

2 5

3 . 2 D i a g n o s a K e p e r a w a t a n

1 . K e t i d a k e f e k t i f a n p o l a n a f a s b e r h u b u n g a n d e n g a n h i p e r v e n t i l a s i

2 . K e t i d a k e f e k t i f a n p e r f u s i j a r i n g a n b e r h u b u n g a n d e n g a n p e n u r u n a n k o n s e n t r a s i

h e m o g l o b i n .

3 . N y e r i k r o n i s b e r h u b u n g a n d e n g a n p e r t u m b u h a n s e l y a n g a b n o r m a l m e n d e s a k

j a r i n g a n s e k i t a r .

4 . K e k u r a n g a n v o l u m e c a i r a n b e r h u b u n g a n d e n g a n k e h i l a n g a n v o l u m e c a i r a n

a k t i f

5 . K e t i d a k s e i m b a n g a n n u t r i s i k u r a n g d a r i k e b u t u h a n t u b u h b e r h u b u n g a n d e n g a n

m u a l d a n m u n t a h

6 . H a m b a t a n m o b i l i t a s f i s i k b e r h u b u n g a n d e n g a n p e n u r u n a n r e n t a n g g e r a k ,

k e l e m a h a n o t o t , n y e r i p a d a g e r a k a n a k i b a t e k s p a n s i t u m o r y a n g c e p a t d a n

p e n e k a n a n k e j a r i n g a n s e k i t a r n y a , p e r d a r a h a n , a t a u d e g e n e r a s i .

7 . R i s i k o c e d e r a b e r h u b u n g a n d e n g a n p e n u r u n a n s p a s m e o t o t d a n k e r a p u h a n

t u l a n g

8 . A n s i e t a s b e r h u b u n g a n d e n g a n p e r u b a h a n s t a t u s p e r a n , f u n g s i p e r a n ,

l i n g k u n g a n , s t a t u s k e s e h a t a n , s t a t u s e k o n o m i , a t a u p o l a i n t e r a k s i .

3 . 3 I n t e r v e n s i

1 ) K e t i d a k e f e k t i f a n p o l a n a f a s b e r h u b u n g a n d e n g a n h i p e r v e n t i l a s i

T u j u a n : S e t e l a h d i l a k u k a n a s u h a n k e p e r a w a t a n s e l a m a 2 j a m , p o l a p e r n a f a s a n

k l i e n k e m b a l i e f e k t i f

K r i t e r i a h a s i l :

a . I r a m a , f r e k u e n s i d a n k e d a l a m a n p e r n a f a s a n d a l a m b a t a s n o r m a l ( r e g u l e r , 1 6 - 2 4

x / m e n i t , I n s p i r a s i : E k s p i r a s i = 2 : 1 )

b . F u n g s i p a r u d a l a m b a t a s n o r m a l ( e k s p a n s i p a r u m a k s i m a l )

c . T i d a k a d a o t o t b a n t u p e r n a f a s a n

d . T i d a k a d a b u n y i n a f a s t a m b a h a n ( r o n k i , w h e z i n g , c r a c l e s )

e . E k s p a n s i d a d a s i m e t r i s

2 6

I n t e v e n s i R a s i o n a l

1 . K a j i k u a l i t a s , f r e k u e n s i d a n

k e d a l a m a n p e r n a f a s a n ,

l a p o r k a n s e t i a p p e r u b a h a n

y a n g t e r j a d i

K i t a d a p a t m e n g e t a h u i s e j a u h m a n a

p e r u b a h a n k o n d i s i k l i e n . F r e k u e n s i

d a n i r a m a n a f a s y a n g m e n g a l a m i

p e r u b a h a n m e r u p a k a n t a n d a a w a l

m u n c u l n y a k e s u l i t a n b e r n a f a s

2 . K a j i a d a n y a p e n g g u n a a n o t o t

b a n t u p e r n a f a s a n ( m i s a l n y a ;

o t o t s t e r n i k l e i d o m a s t o i d ,

a b d o m e n , d i f r a g m a )

O t o t - o t o t a k s e s o r i s i n s p i r a s i b i a s a n y a

t i d a k t e r l i b a t d a l a m p e r n a f a s a n

n o r m a l

3 . P a n t a u p o l a p e r n a f a s a n :

h i p e r v e n t i l a s i , t a k i p n e a ,

b r a d y p n e a , k u s s m a u l ,

s h e y n e s - s t o k e s , a p n e u s i s

U n t u k m e n g i d e n t i f i k a s i s e c a r a d i n i

a d a n y a g a n g g u a n p o l a n a f a s p a d a

p a s i e n

4 . A u s k u l t a s i s u a r a n a f a s ,

p e r h a t i k a n a r e a p e n u r u n a n /

t i d a k a d a n y a v e n t i l a s i d a n

a d a n y a s u a r a n a f a s t a m b a h a n

U n t u k m e n d e t e k s i p e r u b a h a n s u a r a

n a f a s a t a u a d a n y a s u a r a n a f a s y a n g

a b n o r m a l

5 . B e r i k a n p o s i s i s e m i f o w l e r M e n i n g k a t k a n k e n y a m a n a n d a n

m e n g o p t i m a l k a n e k s p a n s i p a r u - p a r u

d e n g a n b a i k

6 . B e r i k a n o k s i g e n a s i s e s u a i

k e b u t u h a n k l i e n

M e m b a n t u m e n g u r a n g i h i p o k s e m i a

d a n m e r i n g a n k a n g a n g g u a n

p e r n a f a s a n

7 . A n j u r k a n p a s i e n u n t u k

m e m a k a i p a k a i a n l o n g g a r

A g a r p o l a p e r n a f a s a n t i d a k

t e r g a n g g u

8 . P a n t a u p e n i n g k a t a n

k e g e l i s a h a n , a n s i e t a s d a n

t e r s e g a l - s e g a l ( l a p a r u d a r a )

S e s a k n a f a s d a p a t m e n g a k i b a t k a n

t i m b u l n y a k e c e m a s a n

2 7

2 ) K e t i d a k e f e k t i f a n p e r f u s i j a r i n g a n b e r h u b u n g a n d e n g a n p e n u r u n a n k o n s e n t r a s i

h e m o g l o b i n .

T u j u a n : S e t e l a h d i l a k u k a n a s u h a n k e p e r a w a t a n s e l a m a 3 j a m , p e r f u s i j a r i n g a n

m e n i n g k a t .

K r i t e r i a H a s i l :

a . T i n g k a t k e s a d a r a n m e n i n g k a t ( k e s a d a r a n : k o m p o s m e n t i s )

b . K o n s e n t r a s i b a i k

c . P e r f u s i j a r i n g a n d a n o k s i g e n a s i b a i k

d . T a n d a - t a n d a v i t a l d a l a m b a t a s n o r m a l ( T D : 1 1 0 / 6 0 m m H g , n a d i : 6 0 - 1 0 0 x / m e n i t ,

R R : 1 6 - 2 4 x / m e n i t , s u h u : 3 6 , 5 - 3 7 , 5 0

C )

e . S y o k d a p a t d i h i n d a r i

I n t e r v e n s i R a s i o n a l

1 . M e m a n t a u n a d i p e r i f e r , e d e m a ,

C R T , t a n d a - t a n d a v i t a l k l i e n

s e c a r a r u t i n

U n t u k m e n g e t a h u i p e r k e m b a n g a n

s t a t u s k e s e h a t a n p a s i e n .

2 . B e r i k a n p o s i s i s e m i f o w l e r p a d a

p a i e n

U n t u k m e m a k s i m a l k a n e k s p a n s i p a r u -

p a r u a g a r p a s i e n m e r a s a n y a m a n

3 . I n f o r m a s i k a n p a d a p a s i e n u n t u k

m e n g h i n d a r i m e l a k u k a n

m a n e u v e r V a l s a v a ( m i s : j a n g a n

m e n g e d a n s a a t d e f e k a s i ) .

M e m i n i m a l k a n k e b u t u h a n O 2 u n t u k

t u b u h

4 . J e l a s k a n p e m b a t a s a n

p e n g g u n a a n k a f e i n , n a t r i u m ,

k o l e s t e r o l d a n l e m a k .

M e m i n i m a l k a n k e b u t u h a n O 2 u n t u k

m e t a b o l i s m e t u b u h

3 ) N y e r i k r o n i s b e r h u b u n g a n d e n g a n p e r t u m b u h a n t u m o r m e n d e s a k j a r i n g a n

d i s e k i t a r n y a .

T u j u a n : S e t e l a h d i l a k u k a n a s u h a n k e p e r a w a t a n s e l a m a 3 - 6 j a m , n y e r i y a n g

d i r a s a k a n k l i e n b e r k u r a n g a t a u k l i e n d a p a t b e r a d a p t a s i d e n g a n n y e r i t e r s e b u t .

2 8

K r i t e r i a H a s i l :

a . S k a l a n y e r i 2 ( 1 - 1 0 )

b . K l i e n t i d a k m e n y e r i n g a i

c . K e l u h a n n y e r i b e r k u r a n g ,

d . K l i e n d a p a t t i d u r d e n g a n t e n a n g

e . R R 1 6 - 2 4 x / m e n i t

I n t e r v e n s i R a s i o n a l

1 . U s a h a k a n m e m b u a t l i n g k u n g a n

y a n g a m a n d a n t e n a n g

M e n u r u n k a n r e a k s i t e r h a d a p e k s t e r n a l

a t a u s e n s i t i v i t a s t e r h a d a p c a h a y a d a n

m e g a n j u r k a n k l i e n u n t u k b e r i s t i r a h a t .

2 . B e r i k a n t i n d a k a n d i s t r a k s i d a n

r e l a k s a s i ( c o n t o h : u b a h p o s i s i

s e t i a p 2 j a m s e k a l i , p i j a t a n p a d a

p u n g g u n g ) d a n a k t i v i t a s

t e r a p e u t i k .

A j a r k a n t e k n i k m a n a j e m e n n y e r i

( c o n t o h : l a t i h a n n a p a s d a l a m ,

v i s u a l i s a s i , i m a j i n a s i t e r b i m b i n g )

d a n s e n t u h a n t e r a p e u t i k .

M e m f o k u s k a n k e m b a l i p e r h a t i a n ,

m e n i n g k a t k a n r e l a k s a s i , d a p a t

m e n i n g k a t k a n k e m a m p u a n k o p i n g

d a n d a p a t m e n u r u n k a n t e r j a d i n y a

n y e r i .

3 . L a k u k a n d a n a w a s i l a t i h a n

r e n t a n g g e r a k p a s i f / a k t i f s e s u a i

k o n d i s i d e n g a n l e m b u t d a n h a t i -

h a t i

D a p a t m e m b a n t u r e l a k s a s i o t o t - o t o t

y a n g t e g a n g d a n d a p a t m e n u r u n k a n

r a s a s a k i t / t i d a k n y a m a n .

4 . K o l a b o r a s i p e m b e r i a n a n a l g e s i k

s e s u a i i n s t r u k s i d o k t e r

D i b e r i k a n u n t u k m e n u r u n k a n n y e r i

d a n / a t a u s p a s m e o t o t .

2 9

4 ) K e k u r a n g a n v o l u m e c a i r a n b e r h u b u n g a n d e n g a n k e h i l a n g a n v o l u m e c a i r a n

a k t i f

T u j u a n : S e t e l a h d i l a k u k a n a s u h a n k e p e r a w a t a n s e l a m a 1 x 2 4 j a m , k e k u r a n g a n

v o l u m e c a i r a n t e r a t a s i

C r i t e r i a h a s i l :

a . K e s e i m b a n g a n e l e k t r o l i t d a n a s a m b a s a

b . A k r a l h a n g a t , t i d a k k e l u a r k e r i n g a t d i n g i n

c . H i d r a s i a d e k u a t

d . S t a t u s n u t r i s i a s u p a n m a k a n a n d a n c a i r a n a d e k u a t

I n t e r v e n s i R a s i o n a l

1 . M o n i t o r i n g t a n d a - t a n d a v i t a l

k l i e n

M e n g e t a h u i k e a d a a n u m u m k l i e n

2 . K a j i a d a n y a t a n d a - t a n d a s y o k

h i p o v o l e m i k

M e n g i d e n t i f i k a s i p e r u b a h a n -

p e r u b a h a n y a n g t e r j a d i p a d a k e a d a a n

u m u m p a s i e n t e r u t a m a u n t u k

m e n g e t a h u i a d a k a h t a n d a - t a n d a s y o k

3 . P a n t a u s t a t u s h i d r a s i

( k e l e m b a b a n m u k o s a , n a d i

a d e k u a t )

M e n g i d e n t i f i k a s i h i d r a s i k l i e n u n t u k

d i l a k u k a n i n t e r v e n s i l e b i h l a n j u t .

4 . M o n i t o r i n t a k e d a n o u t p u t M e m b a n t u d a l a m m e n g a n a l i s a

k e s e i m b a n g a n c a i r a n d a n d e r a j a t

k e l u r a n g a n c a i r a n

5 . A n j u r k a n k l i e n u n t u k

m e n i n g k a t k a n i n t a k e c a i r a n

s e d i k i t n y a 8 g e l a s s e h a r i

M e n g g a n t i k e h i l a n g a n c a i r a n

6 . K o l a b o r a s i d e n g a n p e m b e r i a n

c a i r a n i n t r a v e n a

M e m b a n t u k e b u t u h a n c a i r a n d a l a m

t u b u h

5 ) K e t i d a k s e i m b a n g a n n u t r i s i k u r a n g d a r i k e b u t u h a n t u b u h b e r h u b u n g a n

d e n g a n m u a l d a n m u n t a h

3 0

T u j u a n : S e t e l a h d i l a k u k a n a s u h a n k e p e r a w a t a n s e l a m a 2 x 2 4 j a m , k e b u t u h a n

n u t r i s i t e r p e n u h i

K r i t e r i a h a s i l :

a . T u r g o r b a i k

b . A s u p a n d a p a t m a s u k s e s u a i k e b u t u h a n

c . M u a l d a n m u n t a h b e r k u r a n g b a h k a n h i l a n g

d . B e r a t b a d a n i d e a l ( p e r h i t u n g a n I M T )

e . N a f s u m a k a n m e n i n g k a t

I n t e r v e n s i R a s i o n a l

1 . O b s e r v a s i t e k s t u r d a n t u r g o r

k u l i t p a s i e n

M e n g e t a h u i s t a t u s n u t r i s i k l i e n

2 . K a j i f a k t o r p e n c e t u s m u a l

m u n t a h k l i e n

A g a r b i s a m e n e k a n f a k t o r p e n y e b a b

m u a l d a n m u n t a h

3 . C a t a t w a r n a , j u m l a h d a n

f r e k u e n s i m u n t a h

U n t u k m e m u d a h k a n m e n g i d e n t i f i k a s i

o u t p u t m a k a n a n

4 . K e t a h u i m a k a n a n k e s u k a a n

p a s i e n

A g a r m e n a m b a h n a f s u m a k a n k l i e n

5 . I n s t r u k s i k a n p a s i e n a g a r

m e n a r i k n a f a s d a l a m , p e r l a h a n

d a n m e n e l a n s e c a r a s a d a r

U n t u k m e n g u r a n g i m u a l d a n m u n t a h

6 . T i m b a n g b e r a t b a d a n p a d a

i n t e r v a l y a n g t e p a t

U n t u k m e n g e v a l u a s i e f e k t i f i t a s d a r i

a s u p a n m a k a n a n

7 . L e t a k k a n p o s i s i k e p a l a l e b i h

t i n g g i p a d a w a k t u , s e l a m a d a n

s e s u d a h m a k a n

U n t u k k l i e n l e b i h m u d a h m e n e l a n

k a r e n a g a y a g r a v i t a s i

8 . K o l a b o r a s i d e n g a n d o k t e r u n t u k

m e m b e r i k a n o b a t a n t i e m e t i c

s e b e l u m m a k a n a t a u s e s u a i

d e n g a n j a d w a l y a n g d i a n j u r k a n

O b a t a n t i e m e t i c a d a l a h o b a t u n t u k

m e n g a t a s i m u a l d a n m u n t a h .

3 1

6 ) H a m b a t a n m o b i l i t a s f i s i k b e r h u b u n g a n d e n g a n p e n u r u n a n r e n t a n g g e r a k ,

k e l e m a h a n o t o t , n y e r i p a d a g e r a k a n a k i b a t e k s p a n s i