23例手部腱鞘巨细胞瘤患者术后功能恢复及复发随访结果分析

Analysis on follow-up results of postoperative function and recurrence of 23 patients with tenosynovial giant cell tumor in hand

目的:探讨手部腱鞘巨细胞瘤(TGCT)的术前诊断、手术治疗、功能锻炼及复发因素,为手部TGCT的诊断和治疗提供理论依据。方法:回顾性分析23例手部TGCT患者的临床资料,比较患者术前彩超诊断与术后病理诊断情况,分析手部X线检查结果,随访患者并行浅表局部彩超检查,嘱患者填写《密歇根大学手概况问卷调查表》(MHQ),同时采用E-link测量患者患侧与健侧握力3次,计算患侧手与健侧手的总主动活动度(TAM),评价患者主观满意度和患手功能恢复情况。结果:23例手部TGCT患者,其中包括男性4例,女性19例,年龄18~68岁,平均年龄(48.5±15.1)岁。左手12例,右手11例;局部结节型TGCT(L-TGCT)21例,弥漫型TGCT(D-TGCT)2例。患者的术前彩超诊断结果与术后病理诊断结果均一致,术前X线检查无骨质损害。随访6~26个月,平均随访时间(16.0±6.5)个月,浅表局部彩超检查见肿物复发1例,复发率4.3%。2例D-TGCT患者患侧握力和TAM值较健侧明显降低,21例L-TGCT患者患侧握力和TAM值与健侧比较无明显差异。MHQ得分,80分以下3例,80分以上20例。结论:彻底切除TGCT可降低复发率,术后积极功能锻炼可取得良好的康复效果。

Objective:To explore the preoperative diagnosis,surgical treatment,functional exercise and recurrence factors of tenosynovial giant cell tumor(TGCT)in hand,and to provide the theoretical basis for the diagnosis and treatment of TGCT in hand.Methods:The clinical materials of 23 patients with TGCT in hand were retrospectively analyzed.The preoperative ultrasound diagnosis and postoperative pathology diagnosis of the patients were compared.The X-ray examination results of hands were analyzed.The superficial local ultrasound examination of the patients was followed-up.The patients were asked to fill in the Michigan Hand Outcomes Questionnaire(MHQ),and E-Link was used to measure the grip strength of the affected side and the healthy side of the patients three times,the total active motion(TAM)values of both sides were calculated,and the subjective satisfaction and hand function of the patients were evaluated.Results:There were 23 patients with TGCT in hand,including 4 males and 19 females,aged 18-68 years old,mean(48.5±15.1)years old;among them,12 cases of left-handed,11 cases of right-handed;21 cases of local nodular type TGCT(L-TGCT)and 2 cases of diffuse type TGCT(D-TGCT).The preoperative ultrasound diagnosis result was in accord with the postoperative pathology diagnosis results.There was no bone damage in X-ray examination before operation.The patients were followed up for 6-26 months,mean(16±6.5)months;the results of superficial local ultrasound showed recurrence in 1 case,and the recurrence rate was 4.3%.The grip strength and TAM values of the affected sides in 2 patients with D-TGCT were significantly lower than those of the healthy side;the grip strength and TAM values of 21 patients with L-TGCT had no significant differences compared with the healthy sides.The MHQ scores were less than 80 in 3 cases and more than 80 in 20 cases.Conclusion:Complete resection of TGCT can reduce the recurrence rate,and active functional exercise can achieve good rehabilitation effect.