Prahm Cosima, Kefalianakis Laura, Heinzel Johannes, Kolbenschlag Jonas, Daigeler Adrien, Lauer Henrik
Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Germany.
Arch Plast Surg. 2025 May 15;52(3):137-144. doi: 10.1055/a-2466-4905. eCollection 2025 May.
Enchondromas are the most common primary tumors in the small tubular bones of the hand, and fractures are often the result of thinned cortical bone. The main question was whether fractured enchondromas influence long-term clinical and radiological outcomes. Between 2000 and 2019, 57 patients with previously treated fractured (group I) and non-fractured (group II) hand enchondromas (34 female, 23 male; mean age 39.4 ± 13.7 years) were evaluated for clinical and radiological treatment outcomes. Short Form-36 Health Survey (SF-36) and Disabilities of the Arm Shoulder and Hand (DASH) questionnaires as well as patient-reported experience measures were used to assess subjective health outcomes. Subsequently, 43 patients underwent clinical and radiological follow-ups. Comparative evaluation of objective treatment outcomes in both groups was conducted in terms of hand functionality, perioperative complications, recurrence rates, and osteogenesis. Almost half of the patients suffered enchondromas with fractures (49.1%, = 28). Two patients received additional k-wire stabilization due to intraoperative instability. Defect resolution could be reached in 97.7% ( = 42) of all cases. No recurrence of enchondroma was observed. Groups were equal regarding radiological and clinical outcomes. The patient-reported experiences were predominantly positive (86%), and both cohorts had good to very good results with a DASH mean score of 4 (± 6.3). The SF-36 demonstrated a return to normal quality of life in both groups. The mean follow-up time was 7.78 years (± 4.8). Sole curettage of enchondromas yields effective outcomes with good to excellent results regardless of the presence of a fracture. Long-term radiological follow-up is not required until symptomatic recurrence.
内生软骨瘤是手部小管状骨中最常见的原发性肿瘤,骨折往往是皮质骨变薄的结果。主要问题是骨折的内生软骨瘤是否会影响长期的临床和放射学结果。
在2000年至2019年期间,对57例先前接受过治疗的手部骨折内生软骨瘤患者(I组)和非骨折内生软骨瘤患者(II组)(34例女性,23例男性;平均年龄39.4±13.7岁)的临床和放射学治疗结果进行了评估。使用简短健康调查问卷(SF-36)、手臂、肩部和手部功能障碍(DASH)问卷以及患者报告的体验指标来评估主观健康结果。随后,对43例患者进行了临床和放射学随访。从手部功能、围手术期并发症、复发率和成骨方面对两组的客观治疗结果进行了比较评估。
几乎一半的患者患有骨折的内生软骨瘤(49.1%,n = 28)。两名患者因术中不稳定接受了额外的克氏针固定。所有病例中有97.7%(n = 42)实现了缺损修复。未观察到内生软骨瘤复发。两组在放射学和临床结果方面相当。患者报告的体验主要是积极的(86%),两个队列的DASH平均评分为4(±6.3),结果良好至非常好。SF-36显示两组的生活质量均恢复正常。平均随访时间为7.78年(±4.8)。
无论是否存在骨折,单纯刮除内生软骨瘤都能产生有效结果,效果良好至极佳。在出现症状性复发之前,无需进行长期放射学随访。