手部内生性软骨瘤临床疗效的回顾性分析

发布时间：2018-06-28 19:53

本文选题：内生性软骨瘤 + 病理性骨折　；参考：《吉林大学》2017年硕士论文

【摘要】：目的对于手部内生性软骨瘤的起病特点、诊断治疗方法及术后效果进行临床回顾性研究,通过数据分析影响手部内生性软骨瘤术后手功能的影响因素,总结内生软骨瘤发病特点及治疗经验,为临床诊治提供参考。方法回顾性分析我院2012年01月至2016年06月接受手术治疗并经病理诊断证实的53例手部内生性软骨瘤的临床资料。对影响内生软骨瘤术后转归的影响因素进行统计学分析。分析方法:7个变量作为影响因素:性别、年龄、单发或多发、累及位置、累及范围、是否合并病理骨折及植骨方式。对合并病理性骨折的内生软骨瘤的内固定方式,包括钢板、螺钉内固定和克氏针内固定作为两项自变量,分析内固定方式对术后效果的影响。参照Kazwcki评价手部内生软骨瘤术后功能评价标准评定疗效,分为优良和中差,这两项作为因变量。对手部内生性软骨瘤术后转归的影响因素进行二分类,用卡方检验进行变量分析。P0.05具有统计学意义。结果53例手部内生软骨瘤多见于10岁-40岁患者;男性患者略多于女性患者。男女性在发病位置方面未见明显异常。多发12例,占22.64%,其中数量最多者达3处;手部内生软骨瘤总发病位置中,近节指骨发病率最高,其次掌骨和中节指骨的发病率也较高,远节指骨处较少发病;肿瘤合并病理性骨折的患者23例,占44.40%,全部行内固定物植入。53例内生软骨瘤患者随访的时间为3个月至36个月,平均随访的时间为15个月。术后4-6周及每半年复查X线片,随访期间未见肿瘤复发及恶变。参照Kazwcki评价标准:优31例,占58.49%,良13例,占24.53%,中7例,占13.21%,差2例,占3.77%。优良率为:83.02%。植骨方式中,无植骨6例,优良率100%;同种异体骨29例,优良率79.31%;自体骨18例,优良率83.33%。合并病理性骨折的23例内生软骨瘤患者中:克氏针内固定物植入的有17例,占合并病理性骨折的73.91%,优良率64.71%。钢板、螺钉植入的6例,占26.09%,优良率为83.33%。通过统计学方法(SPSS21.0软件)得出:手部内生软骨瘤术后手功能与是否合并病理性骨折有相关性(P=0.022)。植骨方式无统计学差异,但同种异体骨植骨术后效果好,创伤小,术后并发症少。合并病理性骨折的内生软骨瘤,两种内固定方式术后手功能优良率无统计学差异,克氏针固定牢固,避免二次手术,建议行克氏针内固定。结论:手部内生性软骨瘤是手部最常见、也是最具有破坏性的良性骨肿瘤,好发于10-40岁患者,男女无差异。手部内生性软骨瘤的诊断主要依靠X线检查,CT及MRI对肿瘤早期恶变的发现及诊断具有重要的指导价值。需要注意与骨囊肿、骨样骨瘤、原发性骨肉瘤、Ollier病相鉴别。手部内生性软骨瘤术后手功能的恢复影响与是否合并病理性骨折有相关性,未发现与性别、年龄、单发/多发情况、累及位置、累及范围、植骨方式有相关性。治疗上建议行肿瘤彻底刮除+同种异体骨植骨;对于合并病理性骨折的患者建议尽可能的解剖复位,行克氏针内固定,早期功能锻炼。
[Abstract]:Objective to make a retrospective study on the characteristics of the onset of endogenic chondroma in hand, the diagnosis and treatment methods and the postoperative effects. Through data analysis, the influence factors of hand function after the operation of the endogenic chondroma were analyzed, the characteristics and treatment experience of endophytic chondroma were summarized, and the diagnosis and treatment of the endogenic chondroma were summarized. Methods a retrospective analysis was made in our hospital 201. Clinical data of 53 cases of hand endogenetic chondroma confirmed by surgical treatment and pathological diagnosis in 2 years from 01 months to 06 months of 2016. Statistical analysis of influencing factors affecting the postoperative outcome of endogenetic chondroma. Analysis methods: 7 variables were used as factors: gender, age, single or multiple hair, involvement, involvement, and integration. The internal fixation of endophytic chondroma combined with pathological fractures, including plate, screw internal fixation and Kirschner pin internal fixation, was used as two independent variables to analyze the effect of internal fixation on the postoperative effect. The evaluation of the effect of the functional evaluation criteria after the operation of the hand endophytic chondroma by Kazwcki was divided into excellent and good results. The two items were used as the dependent variables. The factors affecting the postoperative outcome of the adversary's endogenous chondroma were classified into two categories, and the analysis of.P0.05 with chi square test was statistically significant. Results 53 cases of hand endogenetic chondroma were found at the age of 10 years old at the age of 10, and the male patients were slightly more than the female patients. There were 12 cases of abnormal occurrence, 22.64% of them, the most of them were the number of 3. The incidence of proximal phalanx was the highest in the total position of the hand endophytic chondroma, the incidence of the metacarpal and middle phalanges was higher, the distal phalanges were less frequently, 23 cases with tumor combined with pathological fracture were 44.40%, and all the internal fixations were implanted in.53 endogenetic soft. The time of follow-up of osteoma patients was 3 months to 36 months, the average follow-up time was 15 months. 4-6 weeks and six months after the operation, the X-ray films were reviewed, and no tumor recurrence and malignant change were found during the follow-up period. According to the Kazwcki evaluation criteria, 31 cases were excellent, 58.49%, 13, 24.53%, 7, 13.21% and 2, and the good rate of the 83.02%. bone graft was no one. Bone graft in 6 cases, excellent rate of 100%, allograft bone in 29 cases, excellent rate of 79.31%, 18 cases of autogenous bone and 23 cases of endophytic chondroma with excellent rate of 83.33%. combined with pathological fracture: 17 cases with Kirschner's internal fixation, 73.91% of combined pathological fracture, excellent rate of 64.71%. steel plate, 6 cases implanted with screws, 26.09%, and good rate of 83.33%. passing through. The statistical method (SPSS21.0 software) showed that the hand function of the hand endogenetic chondroma was associated with the combination of pathological fracture (P=0.022). There was no statistical difference in the way of bone graft, but the effect was good, the trauma was small, and the postoperative complications were less. The treatment of endophytic chondroma with the pathological fracture, and the hand work after two internal fixation methods. There is no statistical difference in good rate, Kirschner's needle is firmly fixed, and the two operation is avoided, and Kirschner's needle is recommended. Conclusion: hand endogenic chondroma is the most common and most destructive benign bone tumor of the hand. It is found in 10-40 year old patients with no difference between men and women. The diagnosis of endogenous chondroma in hand is mainly based on X-ray examination, CT and MRI It is of great guiding value for the discovery and diagnosis of early malignancy. Attention should be paid to the identification of bone cysts, osteoid osteoma, primary osteosarcoma, Ollier disease. The effect of hand function recovery after the operation of hand endogenetic chondroma is associated with the combination of pathological fractures, sex, age, single / multiple cases, and location, It is suggested that the tumor should be completely removed and allograft bone graft, and that the patients with pathological fracture should be dissected as much as possible, with Kirschner's internal fixation and early functional exercise.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R738.3

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