Bickels Jacob, Wittig James C, Kollender Yehuda, Kellar-Graney Kristen, Mansour Kari L, Meller Isaac, Malawer Martin M
Department of Orthopedic Oncology, Washington Cancer Institute, Washington Hospital Center, George Washington University, Washington DC 20010, USA.
J Hand Surg Am. 2002 Sep;27(5):870-5. doi: 10.1053/jhsu.2002.34369.
Removal by means of curettage is the mainstay of surgical treatment of enchondromas of the hand. Reconstruction traditionally entails filling the tumor cavity with a bone graft, or it may be decided not to perform a reconstruction. In either case a period of protected activity is needed until the tumor cavity has healed. The current study describes the use of cemented internal fixation for the purpose of reconstruction of these cavities. This technique provides immediate mechanical stability and allows early mobilization. Between 1986 and 1999, we treated 13 patients who were diagnosed as having enchondroma of the hand. Surgery included tumor removal with hand curettes and high-speed burr drilling. The remaining tumor cavity was reconstructed by using bone cement and intramedullary hardware. All patients were followed-up for more than 2 years. There were no postoperative infections or fractures, and all patients returned to their presurgical functional capability within 4 weeks. At the most recent follow-up evaluation, none of the patients had local tumor recurrence. Although 7 patients had a decrease in flexion of the metacarpophalangeal or interphalangeal joints, none reported a functional limitation. Reconstruction of the tumor cavity with cemented hardware provides immediate mechanical stability, allows early mobilization, and is associated with good functional outcome.
刮除术是手部内生软骨瘤手术治疗的主要方法。传统的重建方法是用骨移植填充肿瘤腔，或者也可以决定不进行重建。无论哪种情况，在肿瘤腔愈合之前都需要一段时间的保护性活动。本研究描述了使用骨水泥内固定来重建这些腔隙的方法。该技术可提供即时的机械稳定性并允许早期活动。1986年至1999年间，我们治疗了13例被诊断为手部内生软骨瘤的患者。手术包括用手动刮匙和高速磨钻切除肿瘤。剩余的肿瘤腔通过使用骨水泥和髓内固定装置进行重建。所有患者均接受了超过2年的随访。没有术后感染或骨折发生，所有患者在4周内恢复到术前的功能状态。在最近的随访评估中，没有患者出现局部肿瘤复发。虽然7例患者的掌指关节或指间关节屈曲度有所下降，但没有人报告有功能受限。用骨水泥固定装置重建肿瘤腔可提供即时的机械稳定性，允许早期活动，并且功能结果良好。
