外科治疗儿童合并手指偏斜畸形的骨软骨瘤的临床研究

Clinical study on surgical treatment of osteochondroma with finger deviation deformity in children

目的探讨对于儿童合并手指偏斜畸形的骨软骨瘤进行外科治疗的结果。方法本研究纳入自2014年12月至2019年12月我们摄X线片诊断为手部骨软骨瘤的患者21例45块管状骨,其.中18例28块管状骨接受肿瘤切除术及楔形截骨治疗,共11例21块管状骨完成6~24个月的随访。所有患者病理诊断均与术前相符。依据电子病历系统采集患者基本信息及术前伴发症状,经电子影像系统测量术前及术后手指X线正侧位片掌侧倾斜角度、桡尺侧偏斜角度、管状骨长度,并随访有无术后伴发症状,对上述因素进行统计分析。结果骨软骨瘤切除术后手部管状骨桡尺偏斜角度为(5.94±6.62)°较术前(17.06±15.40)°明显改善(P=0.005);术后掌倾角度为(15.03±21.43)°较术前(24.01±25.91)°明显改善(P=0.006)。0~6岁儿童术后偏斜畸形改善最为明显,术后管状骨长度未见明显缩短。获得随访的21块管状骨中3块(14.3%)术后X线片见新发肿物。结论骨软骨瘤切除术及楔形截骨在切除肿瘤的基础上能够有效矫正手指偏斜。

Objective To investigate the clinical efficacy of surgical treatment of osteochondroma with finger deviation deformity in chidren.Methods From December 2014 to December 2019,21 patients with 45 tubular bones diagnosed as osteochondroma of the hand by X-ray were included in this study.Among them,18 patients(28 tubular bones)received tumor resection and wedge osteotomy.A total of 11 patients(21 tubular bones)were follow-up for 6 to 24 months.The pathological diagnosis of all patients was consistent with that before operation.According to the basic information of the patient collected by the electronic medical record system and the concomitant symptoms before operation,the palmar inclination angle,radial ulnar deviation angle and tubular bone length of the X-ray anterioposterior and lateral films of the fingers before and after operation were measured by the electronic imaging system,and whether there were concomitant symptoms after operation was followed up.The above factors were statistically analyzed.Results After osteochondroma resection,the radial and ulnar deviation angle of the tubular bone in the hand was(5.94±6.62)°,which was significantly improved from(17.06±15.40)°(P=0.005).The palm inclination angle was(15.03±21.43)°after operation,which was significantly improved compared with(24.01±25.91)°before operation(P=0.006).Children aged 0 to 6 years had the most obvious improvement in postoperative deflections and deformities,and the length of tubular bone was not significantly shortened after operation.Among the 21 tubular bones that were followed up,3(14.3%)showed new tumors on postoperative X-ray films.Conclusion The osteochondroma resection and wedge osteotomy can effectively correct finger deviation on the basis of tumor resection.