Ollier病手部肿瘤的X线分类及治疗策略  

X-ray classification and treatment strategy of Ollier’s disease in hands

作　　者：卢鹏[1] 田文[1] 田光磊[1] 赵俊会 郭阳[1] 杨勇[1] 刘坤[1] 殷耀斌[1] 孙丽颖 钟文耀 LU Peng;TIAN Wen;TIAN Guang-lei;ZHAO Jun-hui;GUO Yang;YANG Yong;LIU Kun;YIN Yao-bin;SUN Li-ying;ZHONG Wen-yao(Department of Hand Surgery,Jishuitan Hospital,Beijing,100035,China)

机构地区：[1]北京大学第四临床医院北京积水潭医院手外科

出　　处：《中国骨与关节杂志》2019年第10期775-782,共8页Chinese Journal of Bone and Joint

基　　金：国家重点研发计划资助项目(2016YFC0901500)

摘　　要：目的探讨Ollier病手部肿瘤的X线分类方法及治疗策略。方法总结2002年至2017年我科收治的34例共358块短管状骨(掌骨117块,指骨241块)的X线表现,根据每一块骨中肿瘤的生长方式将其分类为:(1)内膨胀生长;(2)中心型膨胀生长;(3)偏心型膨胀生长;(4)混合型膨胀生长;(5)恶性变。分别统计术后患者肿瘤消失的块数及未消失的块数,计算肿瘤消失比例,对比不同分组间治疗效果差异。结果本组34例中21例(172块短管状骨)获10~98个月随访,平均35.5个月。所有患者术后均未出现明显成骨不良导致的病理性骨折。内膨胀型组中有12块(80.0%)肿瘤消失,中心型膨胀组中有16块(34.8%)肿瘤消失,偏心型膨胀组中有23块(48.9%)肿瘤消失,混合型膨胀组中有6块(9.4%)肿瘤消失。Fisher精确检验结果显示,差异有统计学意义(P=0.000)。两两比较显示,肿瘤消失情况在内膨胀组与中心型膨胀组(P=0.003)和混合型膨胀组(P=0.000)差异有统计学意义;在中心型膨胀组与混合型膨胀组差异有统计学意义(P=0.001);在偏心型膨胀组与混合型膨胀组差异有统计学意义(P=0.000)。结论本分类法体现了不同类型间骨骼受累严重程度及治疗效果预估的差异,同时将“内膨胀生长”这一症状不明显的类型以及“恶性变”这一应特殊考虑的类型加入其中,为本病的早期诊断和治疗提供了新的思路。建议采用皮质骨成形术治疗Ollier病的手部内生软骨瘤,不进行植骨术。Objective To propound a new classification of Ollier’s disease in hands by X-ray plain film,and to discuss the treatment strategy.Methods From 2002 to 2017,34 cases with 358 affected bones(117 metacarpal bones,241 phalanges)were treated.X-ray plain films were evaluated,and tumors were classified into 5 categories by its growth pattern:internal expansion;central expansion;eccentric expansion;mixed expansion;malignant transform.The number of tumors disappeared and the number of non-disappeared tumors were counted respectively,and the ratio of tumor disappeared was calculated.Results Twenty-one cases with 172 affected bones were followed up 10-98 months with an average of 35.5 months.Each bone was classified according to the methods described above.No pathological fracture was found in all patients after operation.Tumors in 12(80.0%)bones disappeared in the internal expansion group,16(34.8%)in the central expansion group,23(48.9%)in the eccentric expansion group,and 6(9.4%)in the mixed expansion group.Fisher test showed that the overall differences were statistically significant(P=0.000).Two-by-two comparisons showed that there were statistically significant differences in tumor disappearance rates between the internal expansion group and the central expansion group(P=0.003),internal expansion group and mixed expansion group(P=0.000),central expansion group and mixed expansion group(P=0.001),eccentric expansion group and mixed expansion group(P=0.000).Conclusions New classification method proposed in this study reflects the differences in the severity of skeletal involvement,difficulty of surgical treatment,and predictions of therapeutic effect among different types.We provides a new idea for the early diagnosis and treatment of this disease by adding internal expansion group which is not obvious and malignant transform group which should be considered specially.It is suggested that corticoplasty should be used for the treatment of Ollier’s disease in hand.

关 键 词：内生软骨瘤病 肿瘤 手骨 分类法 

分 类 号：R738.3[医药卫生—肿瘤]