Ali ÇAĞDAŞ, Ahmet Fahir DEMİRKAN, Alp AKMAN, Ali KİTİŞ, Hande USTA

Enjekte edilebilir kalsiyum fosfat çimentosu ile tedavi edilen el enkondromları

Amaç: Bu çalışmanın amacı el enkondromlarının küretajı ve defektin enjekte edilebilir kalsiyum fosfat çimentosu ile tedavi sonuçlarının değerlendirilmesidir. Gereç yöntem: Bu retrospektif çalışmaya 16 hasta dahil edilmiştir. Radyolojik, klinik (ağrı değerleri, eklem hareket açıklıkları) ve fonksiyonel sonuçları (Quick-DASH skorları, kaba ve ince kavrama güçleri) değerlendirilmiştir. Bulgular: Operasyon sonrası hastaların ortalama ağrı skorlarında anlamlı bir azalma saptandı. Bir hasta haricinde tüm hastaların tam eklem hareket açıklığına sahip olduğu saptandı. Yedi hastada yeni kemik oluşumu meydana geldi. Hiçbir hastada ektopik kemikleşme, yara yeri enfeksiyonu ve nüks gözlenmedi. Postoperatif ortalama Quick-DASH skoru 7,3±11,9 idi. Sağlam ekstremite ile karşılaştırıldığında kaba kavrama gücünün %90 ’ının ve pinç kuvvetinin %85-100 ’ünün geri kazanıldığı saptandı. Sonuç: Kalsiyum fosfat çimentosu donör alan morbiditesinin olmaması, erken aktiviteye izin vermesi ve iyi fonksiyonel sonuçlar ile el enkondromlarının tedavisinde değerli bir tedavi alternatifi olduğu düşünülmektedir.

Anahtar Kelimeler:

Kalsiyum fosfat çimentosu, el enkondromları, iyi huylu tümör

Hand enchondromas treated with injectable calcium phosphate cement

Purpose: The purpose of this study was to evaluate the results of hand enchondroma patients treated by curettage and then filling of the defect with injectable calcium phosphate cement.Material and Methods: 16 patients were included in this retrospective study. The radiological, clinical (pain intensity, range of motion) and functional outcomes (Quick-DASH, grip and pinch strengths) were evaluated. Results: There was a significant reduction in mean pain scores post operatively. All patients had full range of motion except 1 patient. New bone formation occurred in seven patients. Ectopic ossification, wound infection and recurrence were not observed in any patient. The mean Quick-DASH score was 7.3±11.9 postoperatively. 90% recovery of grip strength and 85-100% of pinch strength were obtained. Conclusion: Calcium phosphate cement is anticipated as a valuable alternative treatment method of hand enchondromas because of the lack of donor site morbidity, allowing early activity and providing good functional results.

Keywords:

Calcium phosphate cement, hand enchondroma, benign tumors.,

PDF

___

1. Rajeh M Al, Diaz JJH, Facca S, Matheron AS, Gouzou S, Liverneaux P. Treatment of hand enchondroma with injectable calcium phosphate cement: a series of eight cases. Eur J Orthop Surg Traumatol [Internet]. 2016 Dec 9;471(11):3645–52. Available from: http://link.springer.com/10.1007/s00590-016-1888-2
2. Bickels J, Wittig JC, Kollender Y, Kellar-Graney K, Mansour KL, Meller I, et al. Enchondromas of the hand: Treatment with curettage and cemented internal fixation. J Hand Surg Am [Internet]. 2002 Sep;27(5):870–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21704997
3. Kim JK, Kim NK. Curettage and calcium phosphate bone cement injection for the treatment of enchondroma of the finger. Hand Surg [Internet]. 2012 Jan;17(01):65–70. Available from: http://www.worldscientific.com/doi/abs/10.1142/S0218810412500104
4. Figl M, Leixnering M. Retrospective review of outcome after surgical treatment of enchondromas in the hand. Vol. 129, Archives of Orthopaedic and Trauma Surgery. 2009. p. 729–34.
5. Yasuda M, Masada K, Takeuchi E. Treatment of enchondroma of the hand with injectable calcium phosphate bone cement. Vol. 31, Journal of Hand Surgery. 2006. p. 98–102.
6. Takigawa K. “Chondroma of the bones of the hand.” J Bone Jt Surg Am. 1971;58.3:1591–600.
7. Taleb C, Gouzou S, Mantovani G, Liverneaux P. Treatment of benign bone tumours of the hand using osteoscopy. Chir Main. 2010 Apr;29(2):78–81.
8. Yanagawa T, Watanabe H, Shinozaki T, Takagishi K. Curettage of benign bone tumors without grafts gives sufficient bone strength. Acta Orthop [Internet]. 2009;80(1):9–13. Available from: http://www.tandfonline.com/doi/full/10.1080/17453670902804604
9. Ablove RH, Moy OJ, Peimer CA, Wheeler DR. Early versus delayed treatment of enchondroma. Am J Orthop (Belle Mead NJ) [Internet]. 2000 Oct [cited 2017 Jul 11];29(10):771–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11043959
10. Wulle C. On the treatment of enchondroma. J Hand Surg Am. 1990;15(3):320–30.
11. Pianta TJ, Baldwin PS, Obopilwe E, Mazzocca AD, Rodner CM, Silverstein E a. A biomechanical analysis of treatment options for enchondromas of the hand. Hand (N Y) [Internet]. 2013;8:86–91. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3574487&tool=pmcentrez&rendertype=abstract
12. Sassoon AA, Fitz-Gibbon PD, Harmsen WS, Moran SL. Enchondromas of the hand: Factors affecting recurrence, healing, motion, and malignant transformation. Vol. 37, Journal of Hand Surgery. 2012. p. 1229–34.
13. Yercan H, Ozalp T, Coşkunol E, Ozdemir O. [Long-term results of autograft and allograft applications in hand enchondromas]. Acta Orthop Traumatol Turc [Internet]. 2004;38(5):337–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15724115
14. Bauer RD, Lewis MM, Posner MA. Treatment of enchondromas of the hand with allograft bone. J Hand Surg Am [Internet]. 1988 Nov [cited 2017 Jun 22];13(6):908–16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3066817
15. Crawford K, Berrey BH, Pierce WA, Welch RD. In Vitro strength comparison of hydroxyapatite cement and polymethylmethacrylate in subchondral defects in caprine femora. J Orthop Res. 1998;16(6):715–9.
16. Liverneaux P. [Treatment of bony fibrous dysplasia with calcium-phosphate cement: a case report]. Rev Chir Orthop Reparatrice Appar Mot [Internet]. 2003 Oct [cited 2017 Jul 11];89(6):532–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14593290
17. Welkerling H, Raith J, Kastner N, Marschall C, Windhager R, Welkerling H, et al. Painful soft-tissue reaction to injectable Norian SRS calcium phosphate cement after curettage of enchondromas. J Bone Jt Surg [Br] [Internet]. 2003 [cited 2017 Jul 11];85:238–9. Available from: http://www.boneandjoint.org.uk/content/jbjsbr/85-B/2/238.full.pdf
18. Liodaki E, Kraemer R, Mailaender P, Stang F. The Use of Bone Graft Substitute in Hand Surgery: A Prospective Observational Study. Medicine (Baltimore). 2016;95(24):e3631. 19. Decramer A, Leclercq C. Treatment of a Fractured Juxta-Articular Enchondroma of the Middle Phalanx With a Suzuki External Fixator. Tech Hand Up Extrem Surg [Internet]. 2015 Mar [cited 2017 Aug 19];19(1):46–9. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00130911-201503000-0000920. Hung YW, Ko WS, Liu WH, Chow CS, Kwok YY, Wong CWY, et al. Local review of treatment of hand enchondroma (artificial bone substitute versus autologous bone graft) in a tertiary referral centre: 13 years??? experience. Hong Kong Med J. 2015;21(3):217–23. 21. Giles DW, Miller SJ, Rayan GM. Adjunctive treatment of enchondromas with CO2 laser. Lasers Surg Med. 1999;24(3):187–93. 22. Cha SM, Shin HD, Kim KC, Park IY. Extensive curettage using a high-speed burr versus dehydrated alcohol instillation for the treatment of enchondroma of the hand. J Hand Surg Eur Vol. 2015;40(4):384–91. 23. Bachoura A, Rice IS, Lubahn AR, Lubahn JD. The surgical management of hand enchondroma without postcurettage void augmentation: authors’ experience and a systematic review. Hand. 2015;10(3):461–71.
19. A. Decramer and C. Leclercq, “Treatment of a Fractured Juxta-Articular Enchondroma of the Middle Phalanx With a Suzuki External Fixator,” Tech. Hand Up. Extrem. Surg., vol. 19, no. 1, pp. 46–49, Mar. 2015.
20. Y. W. Hung, W. S. Ko, W. H. Liu, C. S. Chow, Y. Y. Kwok, C. W. Y. Wong, W. L. Tse, and P. C. Ho, “Local review of treatment of hand enchondroma (artificial bone substitute versus autologous bone graft) in a tertiary referral centre: 13 years??? experience,” Hong Kong Med. J., vol. 21, no. 3, pp. 217–223, 2015.
21. D. W. Giles, S. J. Miller, and G. M. Rayan, “Adjunctive treatment of enchondromas with CO2 laser,” Lasers Surg. Med., vol. 24, no. 3, pp. 187–193, 1999.
22. S. M. Cha, H. D. Shin, K. C. Kim, and I. Y. Park, “Extensive curettage using a high-speed burr versus dehydrated alcohol instillation for the treatment of enchondroma of the hand,” J Hand Surg Eur Vol, vol. 40, no. 4, pp. 384–391, 2015
23. A. Bachoura, I. S. Rice, A. R. Lubahn, and J. D. Lubahn, “The surgical management of hand enchondroma without postcurettage void augmentation: authors’ experience and a systematic review,” Hand, vol. 10, no. 3, pp. 461–471, 2015.