Pathologic Fracture of the Proximal Phalanx Due to an Enchondroma: A Case Report and Review of Literature

內生性軟骨瘤造成食指近端指骨病理性骨折：一個病例報告及文獻回顧

陳信翰(Hsin-Han Chen) ； 吳肇毅(Chao-I Wu) ； 周爾康(Erh-Kang Chou) ； 鄭旭棠(Hsu-Tang Cheng) ； 許永昌(Yung-Chang Hsu) ； 張家寧(Chia-Ning Chang)

《臺灣整形外科醫學會雜誌》 19卷2期 (2010/06) Pp. 173-179

https://doi.org/10.7096/TJTSPS.201006.0173

摘要

背景：
內生性軟骨瘤是手部最常見的良性骨腫瘤，通常沒有症狀，經常以手指近端指骨的病理性骨折來表現。
目的及目標：
主要是評估及探討手部近端指骨的內生性軟骨瘤的治療及處理，同時也有關於此良性骨腫瘤的文獻回顧及討論。
材料及方法：
一位25歲男性病患因為左手食指在綁鞋帶時突然劇烈的疼痛及變形而到中國醫藥大學附設醫院急診就診，X光檢查為近端指骨骨折且有骨腫瘤，病人接受骨折固定及檢體採樣。病理報告為內生性軟骨瘤，後續病人接受軟骨瘤刮除手術且以自體腸骨移植。
結果：
術後手指外觀正常且活動範圍不管是彎曲或是伸展皆沒有受到限制，手術後兩年的影像學追蹤並沒有腫瘤復發的情形。
結論：
手部的內生性軟骨瘤經常以病理性骨折來表現，同時骨折固定及檢體採樣既可以縮短病人不適的時間，又可以確認診斷。確定是內生性軟骨瘤後再接受刮除手術及自體腸骨移植來重建骨頭，追蹤兩年顯示結果良好。

並列摘要

Background:
Enchondromas are among the most common primary neoplasms of the hand, and often present as pathologic fractures in the proximal phalanx.
Aim and objectives:
Herein we report the management of an enchondroma in the proximal phalanx of the hand. A review on the current literature of this common neoplasm is included.
Materials and Methods:
A 25-year-old man presented to our emergency room with pain and deformity in his left index finger. Open reduction and internal Kirschner wire fixation combined with a biopsy were performed. Pathological examination showed an enchondroma. Intralesional curettage was performed and the bony defect was bridged with an iliac cancellous bone graft.
Results:
The finger had a normal appearance and flexion and extension of the index finger were not functionally impaired. Postoperative radiographic follow up after 2 years did not show recurrence.
Conclusion:
Open reduction and internal fixation combined with biopsy is an optimal approach for treating enchondromas of the hand, which present as pathologic fractures. The approach facilitated a definite diagnosis and shortened the period of disability. Intralesional curettage and an iliac cancellous bone graft for bone loss treatment can be successfully performed for tumor ablation and defect reconstruction.

並列關鍵字

enchondroma ； pathologic fracture ； iliac bone graft ； hand ； finger fracture