Ramos-Pascua Luis R, Bárcena-Tricio Víctor, Casas-Ramos Paula, Sánchez Herráez Sergio, Izquierdo-García Francisco M, Arias Martín Francisco
Department of Orthopaedics, Hospital Universitario de León, León, Spain.
Department of Orthopaedics, Hospital Universitario de León, León, Spain.
J Hand Surg Am. 2018 Sep;43(9):870.e1-870.e7. doi: 10.1016/j.jhsa.2018.02.004. Epub 2018 Mar 16.
To describe the results of nonsurgical and surgical treatment of enchondromas of the distal phalanx of the hand.
Eleven enchondromas of the distal phalanx were retrospectively reviewed. Five patients underwent surgery (curettage and autogenous cancellous bone graft from the iliac crest) and 6 patients were treated nonsurgically. Clinical records and radiographs were reviewed for each patient. We recorded complications and cosmetic and functional results. Radiographic healing in surgical patients was scored according to the classification of Tordai and to the criteria of Wilhelm and Feldmeier. The average follow-up of the nonsurgical and surgical cases was 45 and 62 months, respectively.
Eight patients were women. Average age at diagnosis was 40 years. Nine patients presented with a pathological fracture. The demographic characteristics of the surgical group and nonsurgical group were similar. Among the cases treated nonsurgically (6), 1 had 2 pathological fractures after diagnosis. At final follow-up, the average pain on a visual analog scale was 2.8. With the exception of 1 patient, the range of motion of the fingers was normal or minimally reduced. Among the surgical cases (5), there were no complications in the bone graft donor site, 2 patients developed infections in the operated finger, and no postoperative pathological fractures were found. At final follow-up, the average pain was 3.2. Joint mobility was normal in 3 patients. Postoperative radiological examination revealed complete bone healing in all patients (grade I in the Tordai classification). No local recurrence was seen. According to the criteria of Wilhelm and Feldmeier, there were 3 excellent, 1 good, and 1 satisfactory results in the surgical group, and 2 excellent, 3 good, and 1 satisfactory results in the nonsurgical group.
Surgical and nonsurgical treatment in distal phalanx enchondromas appear to be associated with satisfactory results, although each has their own advantages and disadvantages.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
描述手部远节指骨内生软骨瘤的非手术及手术治疗结果。
对11例手部远节指骨内生软骨瘤进行回顾性分析。5例患者接受手术治疗（刮除术及取自髂嵴的自体松质骨移植），6例患者接受非手术治疗。查阅每位患者的临床记录及X线片。记录并发症、外观及功能结果。根据托尔代（Tordai）分类及威廉（Wilhelm）和费尔德迈尔（Feldmeier）标准对手术患者的影像学愈合情况进行评分。非手术及手术病例的平均随访时间分别为45个月和62个月。
8例患者为女性。诊断时的平均年龄为40岁。9例患者出现病理性骨折。手术组和非手术组的人口统计学特征相似。在接受非手术治疗的病例（6例）中，1例在诊断后发生2次病理性骨折。末次随访时，视觉模拟量表的平均疼痛评分为2.8。除1例患者外，手指活动范围正常或轻度受限。在手术病例（5例）中，骨移植供区无并发症，2例患者手术手指发生感染，未发现术后病理性骨折。末次随访时，平均疼痛评分为3.2。3例患者关节活动度正常。术后影像学检查显示所有患者均实现完全骨愈合（托尔代分类为I级）。未见局部复发。根据威廉和费尔德迈尔标准，手术组3例结果为优，1例为良，1例为可；非手术组2例结果为优，3例为良，1例为可。
手部远节指骨内生软骨瘤的手术及非手术治疗似乎均能取得满意结果，尽管每种治疗方法都有其优缺点。
研究类型/证据水平：治疗性IV级。
Zotero 插件