本文選題：內(nèi)生性軟骨瘤 + 病理性骨折��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的對于手部內(nèi)生性軟骨瘤的起病特點(diǎn)、診斷治療方法及術(shù)后效果進(jìn)行臨床回顧性研究,通過數(shù)據(jù)分析影響手部內(nèi)生性軟骨瘤術(shù)后手功能的影響因素,總結(jié)內(nèi)生軟骨瘤發(fā)病特點(diǎn)及治療經(jīng)驗(yàn),為臨床診治提供參考。方法回顧性分析我院2012年01月至2016年06月接受手術(shù)治療并經(jīng)病理診斷證實(shí)的53例手部內(nèi)生性軟骨瘤的臨床資料。對影響內(nèi)生軟骨瘤術(shù)后轉(zhuǎn)歸的影響因素進(jìn)行統(tǒng)計學(xué)分析。分析方法:7個變量作為影響因素:性別、年齡、單發(fā)或多發(fā)、累及位置、累及范圍、是否合并病理骨折及植骨方式。對合并病理性骨折的內(nèi)生軟骨瘤的內(nèi)固定方式,包括鋼板、螺釘內(nèi)固定和克氏針內(nèi)固定作為兩項(xiàng)自變量,分析內(nèi)固定方式對術(shù)后效果的影響。參照Kazwcki評價手部內(nèi)生軟骨瘤術(shù)后功能評價標(biāo)準(zhǔn)評定療效,分為優(yōu)良和中差,這兩項(xiàng)作為因變量。對手部內(nèi)生性軟骨瘤術(shù)后轉(zhuǎn)歸的影響因素進(jìn)行二分類,用卡方檢驗(yàn)進(jìn)行變量分析。P0.05具有統(tǒng)計學(xué)意義。結(jié)果53例手部內(nèi)生軟骨瘤多見于10歲-40歲患者;男性患者略多于女性患者。男女性在發(fā)病位置方面未見明顯異常。多發(fā)12例,占22.64%,其中數(shù)量最多者達(dá)3處;手部內(nèi)生軟骨瘤總發(fā)病位置中,近節(jié)指骨發(fā)病率最高,其次掌骨和中節(jié)指骨的發(fā)病率也較高,遠(yuǎn)節(jié)指骨處較少發(fā)病;腫瘤合并病理性骨折的患者23例,占44.40%,全部行內(nèi)固定物植入。53例內(nèi)生軟骨瘤患者隨訪的時間為3個月至36個月,平均隨訪的時間為15個月。術(shù)后4-6周及每半年復(fù)查X線片,隨訪期間未見腫瘤復(fù)發(fā)及惡變。參照Kazwcki評價標(biāo)準(zhǔn):優(yōu)31例,占58.49%,良13例,占24.53%,中7例,占13.21%,差2例,占3.77%。優(yōu)良率為:83.02%。植骨方式中,無植骨6例,優(yōu)良率100%;同種異體骨29例,優(yōu)良率79.31%;自體骨18例,優(yōu)良率83.33%。合并病理性骨折的23例內(nèi)生軟骨瘤患者中:克氏針內(nèi)固定物植入的有17例,占合并病理性骨折的73.91%,優(yōu)良率64.71%。鋼板、螺釘植入的6例,占26.09%,優(yōu)良率為83.33%。通過統(tǒng)計學(xué)方法(SPSS21.0軟件)得出:手部內(nèi)生軟骨瘤術(shù)后手功能與是否合并病理性骨折有相關(guān)性(P=0.022)。植骨方式無統(tǒng)計學(xué)差異,但同種異體骨植骨術(shù)后效果好,創(chuàng)傷小,術(shù)后并發(fā)癥少。合并病理性骨折的內(nèi)生軟骨瘤,兩種內(nèi)固定方式術(shù)后手功能優(yōu)良率無統(tǒng)計學(xué)差異,克氏針固定牢固,避免二次手術(shù),建議行克氏針內(nèi)固定。結(jié)論:手部內(nèi)生性軟骨瘤是手部最常見、也是最具有破壞性的良性骨腫瘤,好發(fā)于10-40歲患者,男女無差異。手部內(nèi)生性軟骨瘤的診斷主要依靠X線檢查,CT及MRI對腫瘤早期惡變的發(fā)現(xiàn)及診斷具有重要的指導(dǎo)價值。需要注意與骨囊腫、骨樣骨瘤、原發(fā)性骨肉瘤、Ollier病相鑒別。手部內(nèi)生性軟骨瘤術(shù)后手功能的恢復(fù)影響與是否合并病理性骨折有相關(guān)性,未發(fā)現(xiàn)與性別、年齡、單發(fā)/多發(fā)情況、累及位置、累及范圍、植骨方式有相關(guān)性。治療上建議行腫瘤徹底刮除+同種異體骨植骨;對于合并病理性骨折的患者建議盡可能的解剖復(fù)位,行克氏針內(nèi)固定,早期功能鍛煉。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R738.3

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