Kokubu Yukihiro, Hirose Keisuke, Kurashige Toshinori, Ando Yoshiaki, Marusugi Kiyoma, Kawaguchi Hiroshi
Department of Orthopedic Surgery, Nadogaya Hospital, Chiba, Japan.
J Hand Surg Glob Online. 2025 Jan 27;7(2):249-252. doi: 10.1016/j.jhsg.2025.01.001. eCollection 2025 Mar.
Distal phalanx enchondromas of the thumb are rare and pose unique challenges for surgical management because of the thumb's critical role in hand function. Traditional dorsal and lateral approaches risk damaging extensor tendons, the nail matrix, limiting interphalangeal mobility, or compromising pinch function. This report presents two cases of thumb distal phalanx enchondromas successfully treated using a modified palmar approach with Bruner's incision followed by splitting the insertion of the flexor pollicis longus tendon. Both patients achieved complete curettage, bone regeneration, and full preservation of thumb function at the 1-year follow-up. The incision design avoided high-pressure zones of the pulp, reducing postoperative complications while maintaining functionality. Fluoroscopic guidance facilitated effective curettage through the flexor pollicis longus tendon split without extensive exposure. These findings underscore the tendon splitting palmar approach as a viable option in selected cases, highlighting the importance of individualized surgical strategies to optimize outcomes for distal thumb enchondromas.
拇指远节指骨内生软骨瘤较为罕见，由于拇指在手部功能中起着关键作用，因此其手术治疗面临独特挑战。传统的背侧和外侧入路有损伤伸肌腱、甲床、限制指间关节活动度或损害捏力功能的风险。本报告介绍了两例拇指远节指骨内生软骨瘤患者，采用改良的掌侧入路，即Bruner切口，随后劈开拇长屈肌腱止点，成功治愈。两名患者在1年随访时均实现了完全刮除、骨再生且拇指功能完全保留。切口设计避开了指腹的高压区，减少了术后并发症，同时保持了功能。透视引导有助于通过劈开拇长屈肌腱进行有效的刮除，而无需广泛暴露。这些发现强调了在特定病例中肌腱劈开掌侧入路是一种可行的选择，突出了个体化手术策略对优化拇指远节内生软骨瘤治疗效果的重要性。
