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Umarova Gulrukh, Research Institute of Traumatology and Orthopedics, Ministry of Health of the Republic of Uzbekistan
Tashkent, Uzbekistan E-mail: zn.85@mail.ru
VARIOS METHODS OF SURGICAL TREATMENT OF BENIGN TUMORS OF WRIST BONES
Abstract: The article is devoted to minimally invasive treatment of patients with benign tumors of the musculoskeletal system. The aim of the study is to develop methods for optimizing surgical treatment of bone tumors by minimally invasive access. The material of the study was 15 patients with various benign tumor lesions at the level of the bones of the hand. The technique consisted of minimally invasive access and removal of the tumor using an X-Ray. The defect in the plastic was produced by the collagen allograft, and combined bone plasty was also used.
Keywords: benign, tumor, tumorlike diseases, bone, bone plastic, miniinvazive surgical treatment.
In the structure of tumor diseases the bone neoplasms make up 1-4%. The problem of early detection and treatment of tumor-like diseases of wrist bone diseases does not resolve completely. It is because ofthe anatomical structure of the hand, the variety forms ofbenign tumor, tumor-like and inflammatory diseases, the absence of a unified approach to the classification of nosological forms of diseases, the problems of differential diagnosis, the lack ofa single optimal treatment tactics, a significant number of errors and complications in the form of frequent relapses and violations function of joint. According to various authors, among diseases of the brush, tumors and tumor-like bone processes consist 2% to 13% of cases [2; 5; 6; 8; 12; 18].
The urgency of the problem of bone defect removing aris-ed as a result of cystic formations or bone tumors is a serve issue nowadays. Treatment of patients with benign tumors of the musculoskeletal system is surgical and is aimed at reducing the risk of malignancy, relief of pain syndrome, as well as correction of form and function disorders caused by the tumor [1; 2; 3; 4; 3; 6; 3; 8; 11; 14; 15;16].
The aim of the study is to develop methods for optimizing early diagnosis and surgical treatment of bone tumors through minimally invasive access.
Materials and methods. For 2016-2017 yy, there are 15 patients were treated with various benign tumor lesions at the level of the bones of the hand. The age of patients was from 18 to 50 years. Men and women 1: 2.
Surgical access depended on the localization of the tumor. The technique of performing the operations was that, under the XRay control, the localization of bone formation was determined and marked with a needle. The skin and subcutaneous was cut for 2 cm. The tissues were aparted by blunt method for reached to the bone. The cortical layer of the bone was opened by drill to insert a spoon, and the tumor was removed.
The plastic of the defect in 3 cases was made by bone graft, in 8 cases the cavity was filled with the collagen allograft, in 5 cases was used combined of both.
Control Xrays were performed after 2 months, 6 months and 1.5 years.
All cases, radiologic and clinical indicators were positive.
Case 1. Patient R.- brn in 1990.- Diagnosis: scaphoid bone cyst
Results and discussion:
Analyzing literature data, it was revealed that various devices were used in the diagnosis, localization and treatment of cystic bone formations, such as plates wich used at the preoperative stage. But this method had such limitations as the possibility of using only with small bone formations. Also, the method of computed tomography (CT) at the intraoperative stage was used. But CT has a high radiation load, and the equipment is not available in all clinics [1; 2; 3; 4; 5;7; 9; 12; 13; 16;17].
VARIOS METHODS OF SURGICAL TREATMENT OF BENIGNTUMORS OF WRIST BONES
Case 2. Patient A.- born in 1970.- Diagnosis: an endodromf of semilunar bone
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Case 3. Patient A.- born in 1991.- Enchondroma of the main phalanx of the second finger
The proposed minimally invasive access under the X-ray control is an effective treatment for cystic, tumor and tumor-like diseases of the bones of the hand and wrist. This technique facilitates intraoperative determination of the localization of education and access to the bones, which reduces the size of the incision and traumatization of surrounding tissues.
According to S. A. Petrov. to date, the views of scientists on the methods of surgical treatment and replacement of postre-section defects in the bones of the hand diverge. Controversial views are created with the evaluation of various methods of surgical treatment. Until now, there are no clear indications for certain types of surgical interventions. In the opinion of many authors, the standard method for treating bone neoplasms of the wrist is the removed of the tumor, followed by the plastic of the formed bone defect with spongy auto bone graft (Wulle, S., 1990). Other authors advocate more radical
methods of treatment by segmental marginal resection of the affected bone with removal of the tumor within healthy tissues (Bauliya E. N., 1975).
The plastic of postresection defects in the bones of the hand with autobone transplants that have more pronounced osteogenic properties than allografts has the majority of supporters (Kuftyrev, JI.M., et al., 2000; Goto T. et al., 2002).
A variety of biological transplants, organic, inorganic and synthetic materials are available to replace residual bone defects. However, some of them are ineffective, others are inaccessible, others are technically difficult to harvest and use, or require repeated surgical intervention to extract them (Urazgildeev ZI et al., 1998).
The method of choice for the plasticity of defects was mainly used depending on the size of the formation:
• With a formation size of up to 2 cm, defect plasty was applied using the collagen allograft. The use of allograft
reduces the amount of surgery while ensuring the safety of other bones;
• With defects more than two cm, was used auto bone graft plastic or combined bone plastic, which reduces the risk of autotransplant migration;
• The use of an auto bone graft in the form of a rod for cystic bone formation of the bone diaphysis is important when providing its supporting function.
Minimally invasive access under the X-Ray control is an effective method of surgical treatment for benign cystic tumors and tumor-like diseases of the bones of the wrist. In applying this method, positive results were obtained in 89.1% of cases.
Thus, the primary method of treating patients with benign tumors and tumor-like diseases of the bones of the hand is surgical, aimed at maintaining the limb and
its functions, reducing the risk of malignancy, as well as preventing relapse.
The proposed method minimally invasive access under the control of X-Ray is an effective method of treatment in cystic tumor and tumor-producing diseases of the bones of the hand and wrist. This method facilitates the intraoperative determination of the localization of bone formation, which decreases the size of the incision and traumatization of surrounding tissues.
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