Lin Sung-Yen, Huang Peng-Ju, Huang Hsuan-Ti, Chen Chung-Hwan, Cheng Yuh-Min, Fu Yin-Chih
Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
J Hand Surg Am. 2013 Jan;38(1):104-9. doi: 10.1016/j.jhsa.2012.08.045. Epub 2012 Nov 28.
Enchondroma of the hand with a pathologic fracture is generally treated by tumor curettage and bone grafting after the fracture has healed. However, delayed surgery postpones definitive diagnosis and prolongs the period of disability. We have treated pathologic fractures in a single stage through a modified lateral surgical approach with curettage of the tumor and stabilization using injectable calcium sulfate cement. The aim of this study was to report the outcomes of treatment with this material and the modified approach.
Between 2006 and 2010, we enrolled 8 patients with solitary hand enchondromas and pathologic fractures. The surgical procedure involved a lateral approach, an extended lateral cortical window, thorough tumor evacuation, and reconstruction of the bone defects using commercially available injectable calcium sulfate cement. We performed evaluations before surgery and in the postoperative follow-up series by radiographs and clinical assessments, including measurement of joint motion by goniometry and a visual analog pain scale.
The average time of follow-up was 19 months (range, 12-36 mo). The pathologic fractures of all patients healed clinically and radiographically within 8 weeks after surgery, and the mean active motion arcs of the metacarpophalangeal joints and proximal interphalangeal joints of the involved digit were 90° and 94°, respectively at 3-month follow-up. All patients returned to ordinary daily activities without obvious pain by 3 months postoperatively. We found no major complications, such as unacceptable alignment, nonunion, infection, or tumor recurrence, during follow-up.
This study demonstrated the outcomes of early management of phalangeal enchondromas with pathologic fractures using a lateral approach and injectable calcium sulfate cement for reconstruction. This combined approach avoided the need for supplemental internal fixation, allowed early mobilization, and resulted in minimal joint stiffness.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
手部内生软骨瘤合并病理性骨折通常在骨折愈合后通过肿瘤刮除和植骨治疗。然而，延迟手术会推迟明确诊断并延长残疾期。我们采用改良外侧手术入路，一期处理病理性骨折，刮除肿瘤并使用可注射硫酸钙骨水泥进行稳定固定。本研究的目的是报告使用这种材料和改良手术入路的治疗结果。
2006年至2010年期间，我们纳入了8例手部单发内生软骨瘤合并病理性骨折的患者。手术步骤包括外侧入路、扩大的外侧皮质骨窗、彻底清除肿瘤以及使用市售可注射硫酸钙骨水泥重建骨缺损。我们在术前及术后随访系列中通过X线片和临床评估进行评价，包括使用测角器测量关节活动度和视觉模拟疼痛量表。
平均随访时间为19个月（范围12 - 36个月）。所有患者的病理性骨折在术后8周内临床及影像学愈合，随访3个月时，患指掌指关节和近端指间关节的平均主动活动弧度分别为90°和94°。所有患者术后3个月均恢复日常活动且无明显疼痛。随访期间未发现严重并发症，如不可接受的对线不良、骨不连、感染或肿瘤复发。
本研究展示了采用外侧入路和可注射硫酸钙骨水泥重建治疗指骨内生软骨瘤合并病理性骨折的早期治疗结果。这种联合方法避免了补充内固定的需要，允许早期活动，并使关节僵硬程度降至最低。
研究类型/证据水平：治疗性IV级。
