The Application Of Allogeneic Bone In The Treatment Of Hand Enchondroma

BackgroundEnchondroma is the most common benign bone tumor of hands, andthe incidence ratio between male and female is equal, which is possiblymade by the falsificaion of chondrocytes. As there are many small jointsand articular cartilages in hands with frequent activities, chondrocytes aremore likely to occur falsificaion. Enchondroma is the common benigntumor of the short tubular bones in hands, which accounts for90%ofhand bone tumors, meanwhile about35%enchondroma occurs in thehands, and the most common location is the proximal phalanx, followedby the metacarpal and middle phalanx, rarely occurring in the distalphalanx, and seldomly occurring in the wrist. It can occur singly ormultiply and grows slowly with no obvious symptoms usually, and mostpatients can not be diagnosed until they present with painless swelling,pain, finger deformity or pathological fracture. X-ray combined withclinical manifestations can basically confirm the diagnosis, and the thetypical X-ray presentations are that the involved backbone ormetaphyseal has lower density areas or shows as frosted glass-like, withclear boundary, and most is oval, when the tumor is larger the cortical canexpand to around and be thinner obviously, and the lesions may be uniform in central or show a slight eccentricity, and there are punctatecalcification points within the lesions. CT and MRI can help the diagnosis.The diagnosis of enchondroma mainly depends on the histologicalexamination, in the treatment, patients with small tumors and slowdevelopment can not be performed surgery temporarily, but should beclosely observed and periodically reviewed; while patients withsymptoms, larger tumors, rapid development, obvious deformity, thinnercortical bone or pathological fractures should be treated surgically, andthe effects of surgery are better. The common surgical methods includesimple curettage, curettage and bone grafting, involved bone resectionand finger cutting surgery, etc., and the bone graft material can be takenfrom the autologous bone but also from the allogeneic. Allogeneic bonetransplantation can simplify the surgical procedures, reduce thepostoperative complications, and reduce the clinical pain of patients withmore and more clinical application.Objective:To investigate the efficacy of allogeneic bone in the treatment ofenchondromaMaterials and Methods:Case dataThe clinical data were taken from hand surgery in our hospital inMarch2013-2014March, patients all underwent surgery, and were diagnosed as enchondroma by the pathology of our hospital. The lesionlocation was the hand. There were a total of20cases, with8males and12females; the youngest was18years old, the maximum was50years,and the mean age was33years old; there were all singly occurring cases,and there were9cases in left hand,11cases in right hand, among themthere were9cases with proximal phalanx involved,7cases with phalanxinvolved,2cases with distal phalanx involved, They were divided into13cases of central type and7cases of eccentric type according to X-rayfindings of tumors.2. TreatmentPatients routinely underwent hand X-ray examination afteradmission, if necessary, added the CT and MRI examination, afterfinishing the relevant inspections, if no contraindication for surgery,surgical treatment was performed. According to the different lesionlocations of patients, different surgical approaches were used to revealand do surgery, such as taking the dorsal in metacarpal, taking the ulnaror the vertical incision of the radial in phalanges. For patients withoutdeformity or obvious deformity, fenestration in the lesion locations,thoroughly scraping the lesion, the inactivation of residual lesions in thetumor cavity, and the implantation of enough allogeneic bone (providedby Xin Kangchen Medical Technology Development Co., Ltd. in Beijing)after repeatedly washing the tumor cavity with sterile injection water were mainly performed, but for patients with deformity, the first step wasto correct the deformities, and then to scrape the lesions, and perform thebone graft treatment. Finally, according to the location, scope, size oflesions, and the cases of affected fingers to decide whether to use the steel,Kirschner wire and other fixed equipment to be effectively fixed. The lastwas to fix with plaster slab. Lesions after surgery underwent conventionalpathological ex3. Postoperative treatment①The scraped tumors were routinely underwent pathologicalsection examination.②Three to four weeks after surgery, the protective function exerciseof hands was performed under the protection of the outer fixed brace,after the gradual strengthening functional exercise for4weeks, thefunction exercise of hands gradually started.③Four weeks after surgery, X-ray was reviewed and Kirschner wirewas removed. For example, after the steel plate fixation for3to5months,X-ray was reviewed, according to the bone fusion cases to decide thetime to remove the mini-plate.Follow-up:According to the patient’s condition, telephone follow-up wasperformed, and the patient was asked to return to the hospital for reviewat any given time, the review included asking patients’ subjective satisfaction, checking the affected fingers with or without the presence ofswelling, deformity and pain, the motion range of joints, the size of pinchforce, and to observe whether there was shortening deformity orosteoarthritis in affected fingers by conventional X-ray examination, withor without the presence of tumor recurrence. Then the therapeutic effectsafter treatment were assessed using the postoperative functionalevaluation criteria of Kazwcki hand enchondroma.Evaluation Criteria:All the patients were followed up for1to15months. Thetherapeutic effects after treatment were assessed according to thepostoperative functional evaluation criteria of Kazwcki handenchondroma:①the shape ofaffected fingers was normal or nearlynormal;②the active movement range of affected fingers was80%of thecontralateral ones;③the pinch force of affected fingers was80%of thecontralateral ones;④X ray examination confirmed that the affectedfingers had no shortening deformity or osteoarthritis, and the tumor didnot recur.Results:Patients all were followed up, and use the allogeneic bonetransplantation, the mean operative time of patients was1.66±0.55hours(0.8-3hours), and the average intraoperative blood loss was188.57±72.65ml (80-400ml). The incision of all patients healed without infection, allogeneic bone rejection and other complications. Thefollow-up time was1to15months, with an average of10months, andthe subjective satisfaction degree of all patients was higher, and theefficacy was assessed using Kazwcki evaluation criteria, in this groupthere was excellent in15cases, good in4cases, medium in one case, badin zero case, with good rate of95%.ConclusionAllogeneic bone treatment for hand enchondroma has good effects.It is worthy of clinical application.