Заболевания суставов и костей существенно снижают двигательные возможности человека, а в некоторых случаях приводят к развитию опухолевых и воспалительных процессов хрящевой ткани. Разновидность подобной аномалии – энхондрома, природа возникновения которой до конца не выяснена.
Энхондромой называют доброкачественное новообразование, которое формируется из хрящевой ткани и локализуется внутри костей – либо коротких (фаланги пальцев), либо длинных (бедренной, плечевой), составляющих верхние и нижние конечности. Также известны случаи обнаружения подобной опухоли в тканях мозга, яичниках, молочных железах. Обычно энхондрома представляет собой одиночный очаг, но может иметь множественный характер, приобретая более упорядоченную структуру.
Опухоль по структуре является зрелым гиалиновым хрящом, клетки которого располагаются хаотично и отличаются по формам и размерам. Она покрыта надхрящницей, а внутри нее формируются некрупные очаги окостенения. Эти новообразования растут достаточно медленно и относятся к группе доброкачественных, но не исключается вероятность их озлокачествления.
Энхондромы начинают формироваться еще в детском возрасте, поэтому патологию диагностируют у пациентов в возрасте до 30 лет, чаще всего в период от 11 до 16 лет. Выявить эти новообразования достаточно сложно: они не характеризуются специфическими симптомами, поэтому пациент не выражает каких-либо жалоб, которые могут послужить поводом к проведению диагностических мероприятий.
На фото стрелкой указано, где обычно расположена энхондрома
Причины развития и процесс формирования опухоли
Факторы риска, под действием которых образуются новообразования кости, до сих пор не описаны. Достоверно известно, что патология не связана с воздействием на организм химических и радиоактивных веществ, или же с профессиональной деятельностью пациента, хотя ранее именно эти причины считали основными провокаторами.
Доподлинно известно, что энхондрома развивается еще в период внутриутробного развития и связана с пороком развития костной ткани плода. Другая вероятная причина формирования опухоли – рахит, а также некоторые воспалительные процессы костной ткани, протекающие в организме.
Развивается новообразование из участков хряща в тех местах, где при нормальных условиях хрящевая ткань отсутствует. Опухоль вызывает деформации пораженной области. Межклеточное вещество становится менее вязким, формируются кисты.
Хрящевая ткань, из которой образуется опухоль, гораздо менее плотная и твердая, поэтому не рассчитана на повышенные нагрузки. Именно с этим связано то, что кость, в которой располагается новообразование, теряет прочность, и любое, даже незначительное, повреждение может вызвать перелом.
В зависимости от распространенности патологического процесса выделяют одиночную энхондрому, которая поражает одну кость (чаще всего бедренную), либо множественную, при которой поражаются несколько структур, например, бедро, колено и стопа.
Симптомы поражения бедренных костей
Характерными чертами энхондромы в области бедра являются:
- наличие уплотненного безболезненного образования, которое обнаруживается пальпаторно;
- ограничение подвижности в пораженном месте, если опухоль достигает больших размеров и оказывает давление на расположенные поблизости нервы и сосуды, суставы;
- частые переломы, даже при незначительных ушибах;
- появление припухлости над пораженным участком;
- появление боли в бедре, которая становится более интенсивной при надавливании и проявляется преимущественно в ночное время суток; боль может отдавать в область колена либо другие участки нижней конечности.
Постановка диагноза
Сложность диагностики заключается в скудной симптоматике, особенно в том случае, если размеры опухоли незначительны. Обычно ее обнаруживают случайно в процессе обследования, связанного с другими заболеваниями.
Основной метод выявления экхондромы – рентгенологическое исследование. На полученных в ходе мероприятия снимках обнаруживают нетипичное просветление, локализующееся в структуре бедренной кости, которого в норме быть не должно. Рентген не является единственным методом, который позволяет однозначно установить диагноз. Дополнительными методами исследования в данном случае являются:
- Компьютерная томография. С помощью этого метода визуализации можно получить полную картину относительно структуры энхондромы.
- Биопсия. Процедуру выполняют при подозрении на озлокачествление процесса. Забор материала осуществляют сразу на нескольких участках пораженной области, что повышает точность результатов.
- Дифференциальная диагностика. В данном случае исключают вероятность таких патологий со сходными признаками: костная киста, хондросаркома, гигантоклеточная костная опухоль.
Специалисты отмечают, что при хрящевых опухолях очень сложно отличить доброкачественный процесс от злокачественного.
Способы лечения
Подход к лечению энхондромы бедренной кости зависит от того, какие масштабы принимает патологический процесс. Если опухоль невелика, пациенту назначают консервативное лечение и периодическое прохождение рентгенологического исследования, чтобы контролировать ее рост.
Если новообразование сформировалось в длинных костях, к которым относится бедренная и плечевая, рекомендуется хирургическое удаление, поскольку существует потенциальная опасность трансформации клеток в злокачественные. Энхондромы, образующиеся в коротких костях, менее склонны к переходу в стадию ракового заболевания.
Стремительно развивающиеся опухоли длинной кости требуют обширного хирургического вмешательства: в ходе операции производят удаление патологической жидкости, содержащейся в полостях костей, но без воздействия на стенки. Если есть подозрение на развитие злокачественного процесса, проводят сегментарную резекцию пораженной кости, а иногда и ампутацию.
В образовавшуюся полость вводят специальный препарат на основе сульфата кальция. Он представляет собой своеобразную матрицу для образования новой костной ткани и постепенно заполняет удаленные участки.
Если имеются метастазы, после операции назначают курс химиотерапии или облучения. В реабилитационный период пациенту назначают методы физиотерапевтического лечения, массаж, лечебную физкультуру.
Прогноз данной патологии при правильно проведенном лечении в большинстве случаев благоприятный. После хирургического вмешательства остается риск рецидива, но это касается только тех случаев, если резекция имела не радикальный характер.
Можно ли предупредить?
Конкретных рекомендаций, которые позволили бы избежать формирования энхондромы, нет, что связано с отсутствием исчерпывающей информации относительно причин ее возникновения.
Снизить риск можно посредством ведения здорового образа жизни, занятий спортом, правильного питания. Беременным женщинам, во избежание формирования пороков и патологий плода, следует контролировать состояние здоровья и отказаться от вредных привычек.
Энхондрома бедренной кости – доброкачественное новообразование, которое может трансформироваться в раковое. Чтобы не допустить этого, следует обращаться к специалисту при первых же нетипичных симптомах.
Энхондрома — это доброкачественное новообразование, состоящее из клеток костной ткани и локализующееся в полости трубчатых костей. По мере разрастания опухоли разрушаются костные структуры, что приводит к ограниченности подвижности, постоянным болям и инвалидности. Требует комплексного лечения, направленного на устранение первопричины и ликвидацию последствий прогрессирования опухолевого процесса.
Причины возникновения заболевания
Опухоль представляет собой хрящевое новообразование, располагающееся в том месте, где его быть не должно. Имеет дольчатое строение и склонна к быстрому росту. Основная причина, почему хрящевая ткань появляется в местах локализации костной ткани, — это нарушение процесса окостенения в период внутриутробного развития плода.
Косвенно на процесс окостенения могут влиять такие факторы, как:
- Развитие рахита, острый дефицит кальция и витамина D, необходимого для его полноценного усвоения. Патология чаще встречается у детей дошкольного возраста, связана с неправильным питанием и нарушением процессов усвоения питательных веществ.
- Частые травмы кости, при которых нарушается целостность костной ткани. Естественные процессы регенерации провоцируют активный синтез гиалиновых клеток, что вызывает их избыток и дальнейшее накопление в полости кости.
- Заболевания воспалительного характера, поражающие костные структуры. Ревматоидный артрит и другие патологии, протекающие в хронической форме, провоцируют снижение местного иммунитета, на фоне чего запускаются естественные процессы регенерации, протекающие с участием хрящевых клеток.
В группу риска попадают люди, активно занимающиеся спортом, дети дошкольного возраста, склонные к развитию рахита, пожилые люди, страдающие ревматоидными формами артрита.
Локализация и характерные симптомы
Чаще всего энхондрома поражает трубчатые кости руки и ноги, но может встречаться и в таких местах локализации:
- кисти;
- ребра;
- кости бедра;
- фаланги пальца;
- плечевой и коленный сустав.
Опасность заболевания в том, что его проявления на начальных стадиях практически отсутствуют. Мелкие единичные новообразования, расположенные в полости кости, дают о себе знать только при достижении крупных размеров. Заболевание обнаруживается случайно при проведении рентгенографии по другому поводу.
Когда энхондрома достигает размеров, оказывающих давление на близлежащие костные структуры, начинается их деформация. Проявляется это в виде шишки в области коленного сустава, пальца руки, ступни. При пальпации острые болезненные ощущения отсутствуют.
Кожные покровы в области новообразования умеренно гиперемированы. Нарастающие болезненные ощущения связаны с ростом опухоли и сдавливанием близлежащих кровеносных сосудов и нервных окончаний. Нарушение кровотока приводит к развитию местной гипоксии и интоксикации, когда обменные межклеточные процессы нарушены. Недостаточное поступление крови не позволяет насытить клетки кислородом и забрать все шлаки и токсины.
Хрящевая ткань, прорастающая в кость, снижает ее прочность. Это увеличивает риски развития перелома даже при получении незначительной травмы.
Дополнительные симптомы развиваются при запущенных формах заболевания:
- тупая ноющая боль, которая не проходит в состоянии покоя;
- усиление боли при движении;
- ограниченность подвижности;
- скованность движений;
- изменение области сустава или костных структур.
Если энхондрома локализуется в области большеберцовой кости, изменяется походка человека. Появляется хромота, что объясняется уменьшением длины пораженной кости по отношению к здоровой конечности.
Расположение опухоли в области суставов приводит к появлению синовитов. Застойные процессы, образованные по причине нарушения оттока экссудата, способствуют образованию воспалительного процесса. Это отягощает процесс диагностики и лечения.
Методы диагностики
Постановка диагноза и его подтверждение осуществляется поэтапно. Вначале собирается анамнез, выявляется предрасположенность и патологические факторы, способствующие развитию заболевания. После этого производится осмотр больного и пальпация выступающего участка кости. Для подтверждения диагноза и дифференциации типа опухоли прибегают к помощи аппаратной диагностики:
- МРТ и КТ — показывают наличие опухоли, ее структуру и тип. Злокачественные формы хорошо видны на рентген-контрасте.
- Рентгенография — помогает установить наличие опухоли и место ее локализации, но не дает точных данных о структуре и типе новообразования.
- Биопсия — показывает тип опухоли, выявляя наличие рака. Осуществляется с помощью пункции, содержимое которой отправляют на цитологическое и гистологическое исследование.
Дифференциальная диагностика осуществляется с такими заболеваниями, как:
По мере прогрессирования заболевания оказывается негативное воздействие на кровеносные сосуды и нервные окончания, поэтому потребуется консультация сосудистого хирурга и нейрохирурга.
Всегда существуют риски злокачественных деформаций опухоли, поэтому больному рекомендуется проконсультироваться с онкологом.
Способы лечения
Эффективное лечение энхондромы возможно только при комплексном подходе, включающем такие способы терапии:
- Хирургическая операция — опухоль иссекается вместе с частью здоровых тканей, после чего осуществляется частичное или полное протезирование. В случае локализации новообразования в мелких костях, может потребоваться полная ампутация пальца руки или фаланги. Показанием к операции служит стремительный рост опухоли и ее расположение в непосредственной близости к крупным сосудам, нервам и костным структурам.
- Медикаментозная терапия — направлена на снижение болезненных ощущений и замедление роста опухоли посредством контроля процесса кальцификации. Назначаются поливитаминные препараты, насыщающие организм всеми необходимыми компонентами. Показана противовоспалительная терапия, анальгетики, снижающие боль.
- Физиотерапия — способствует нормализации обменных процессов в костной ткани, тормозит рост гиалинового хряща. Назначается при поражениях бедренной кости, колена, лопатки, конечностей. Используется магнитотерапия, лекарственный электрофорез, лазеротерапия.
Врачи настоятельно рекомендуют бороться с проблемой, как только был поставлен диагноз. Не стоит ждать, пока опухоль достигнет больших размеров. Ее удаляют до тех пор, пока не задеты сосуды и нервные окончания. Прогрессирующая энхондрома имеет менее благоприятные прогнозы. Увеличиваются риски развития осложнений, вплоть до инвалидизации.
Важно придерживаться соответствующей диеты, нормализующей обменные процессы в организме. Следует ограничить потребление соли и сахара, копченых и жареных блюд, солений и маринадов. Рацион составляют из нежирных сортов мяса и рыбы, свежих овощей и фруктов, кисломолочных продуктов.
Заключение
Энхондрома состоит из хрящевых клеток, склонных к активному делению. Отсутствие должной терапии провоцирует развитие осложнений. Только комплексный подход в лечении позволяет добиться желаемых результатов. Ранняя диагностика и лечение дают благоприятный прогноз на полное выздоровление.
Категорически запрещено заниматься самолечением и использовать рецепты нетрадиционной медицины. Опухоль невозможно устранить без хирургической операции. Никакие современные препараты не могут вызвать ее полного уничтожения, поэтому терапия осуществляется под пристальным контролем группы врачей.
Энхондрома – это доброкачественная опухоль, происходящая из хрящевой ткани. Локализуется в области суставов и тела кости. В большинстве случаев протекает бессимптомно, но крупные опухоли могут вызывать нарушение двигательной функции. Перерождение в злокачественную опухоль наблюдается крайне редко. Лечение проводится хирургическим способом.
Характеристика патологии
Энхондрома представляет собой доброкачественное новообразование из клеток зрелого хряща. Опухоль носит гетеротопический характер — то есть локализуется там, где в норме хрящевой ткани нет. Энхондромы диагностируются в 10% случаев всех новообразований хрящевой и костной ткани.
Более чем половина пациентов имеет возраст младше 40 лет. В основном болезнь диагностируется у подростков 11-16 лет. Опухоли бывают одиночными и множественными. По МКБ 10 патология имеет код D16, что означает доброкачественное новообразование костной и хрящевой ткани.
Несмотря на то, что энхондромы редко перерождаются в злокачественные опухоли, они считаются потенциально опасными. Поэтому при выявлении такого новообразования рекомендуется его удаление.
Опухоль представлена зрелой хрящевой тканью, но с утраченной структурой. Клетки измененной хрящевой ткани располагаются хаотично. Внутри опухоли образуются очаги окостенения, кисты. Опухоль имеет дольчатое строение, снаружи покрыта надхрящницей.
Локализуются энхондромы в коротких трубчатых костях – фаланги пальцев. Реже наблюдаются в бедренной и плечевой костях. Плоские кости – таз, лопатка – поражаются крайне редко.
Множественные опухоли выделяют в отдельную патологию – хондроматоз или болезнь Олье. Патологические очаги покрывают всю конечность или половину тела. Болезнь является врожденной и имеет наследственное происхождение. Первые признаки заболевания выявляются в период интенсивного роста костей. Основные симптомы – отставание ребенка в росте, деформация костей. Часто наблюдаются патологические переломы.
Причины
Причина энхондромы до сих пор не установлена. Возникновение опухоли связывают с нарушением процесса окостенения хрящевой ткани во внутриутробном и раннем детском периоде. Предполагают, что этот процесс может быть связан с генетическими нарушениями или травмами.
Многие специалисты считают, что провоцировать развитие болезни может рахит.
Клиническая картина
Симптомы болезни достаточно скудные. Большинство некрупных опухолей никак себя не проявляет. Если опухоль на кости достигает значительных размеров, становится видна деформация конечности. При прощупывании опухоль определяется как плотное безболезненное образование с четкими границами.
Крупные опухоли сдавливают сосуды и нервные волокна, что приводит к появлению болевых ощущений, чувствительных и температурных нарушений. Расположение энхондромы близко к суставу вызывает развитие двигательной дисфункции конечности.
Характерным признаком энхондромы является более частое возникновение переломов даже при небольшой нагрузке. Это обусловлено тем, что хрящевая ткань менее прочная, чем кость.
Клиническая картина будет несколько различаться и в зависимости от локализации опухоли:
- Энхондрома бедренной кости. Обнаруживается плотное безболезненное образование. При достижении им больших размеров отмечается нарушение двигательной функции. Над очагом поражения появляется припухлость. Иногда возникает боль в бедре, которая усиливается в ночное время;
- Энхондрома коленного сустава. Человека беспокоит незначительная боль в области колена, которая усиливается при ходьбе, подъеме по лестнице. При значительном увеличении опухоли возможна деформация сустава;
- Энхондрома большеберцовой кости. В области голени хорошо заметны даже небольшие образования, так как мышечный слой здесь достаточно тонкий. Здесь энхондрома редко достигает больших размеров, симптоматика практически отсутствует.
Часто заболевание выявляется случайно, при обследовании по другим поводам.
Осложнения
Энхондрома дает немного осложнений. Самыми распространенными из них являются патологические переломы костей. Озлокачествление опухоли наблюдается крайне редко.
Чаще перерождение в злокачественную опухоль наблюдается при энхондроме бедренной кости.
Диагностика
Для постановки диагноза достаточно рентгенологического исследования. На рентгеновском снимке хорошо видны очаги просветления внутри кости – включение хрящевой ткани. Внутри этого просветления могут наблюдаться участки затемнения — это уже кальцифицировавшиеся очаги. Опухоль занимает большую часть поперечника кости или полностью весь поперечник.
Более информативным, чем рентген, методом является компьютерная томография. С ее помощью можно послойно оценить структуру энхондромы, обнаружить признаки озлокачествления. МРТ используется для оценки состояния окружающих кость мягких тканей.
Лабораторные методы диагностики непоказательны. При подозрении на развитие злокачественной опухоли выполняют биопсию с последующим гистологическим исследованием.
Методы лечения
Лечебная тактика зависит от локализации и размеров опухоли. Энхондромы фаланг пальцев стопы и кисти редко становятся злокачественными и не достигают больших размеров. Пациенту требуется динамическое наблюдение с регулярными рентгенологическими обследованиями. Консервативное лечение энхондромы носит симптоматический характер. При появлении болевых ощущений назначают препараты из группы НПВС (нестероидные противовоспалительные средства) или анальгетики. Хорошим эффектом обладает физиотерапевтическое лечение.
Иногда вылечить энхондрому консервативно не получается. При обнаружении крупных опухолей рекомендуется хирургическое их удаление. Как лечить энхондрому хирургически? Операцию рекомендуют проводить в следующих ситуациях:
- Достижение опухолью больших размеров, сопровождающееся неврологическими нарушениями и расстройством кровообращения;
- Деформация конечности;
- Расположение опухоли на бедренной кости.
Подготовка к оперативному вмешательству включает оценку общего состояния и локального статуса. Пациент должен сдать все общеклинические анализы и пройти заключение у терапевта. Затем хирург определяет размеры и расположение энхондромы на кости — от этого будет зависеть тактика оперативного вмешательства.
Операция противопоказана в следующих ситуациях:
- Наличие декомпенсированных заболеваний сердца, печени, почек;
- Острое инфекционное заболевание;
- Индивидуальная непереносимость средств для наркоза.
Проводится операция в стационарных условиях под общим обезболиванием. Хирург удаляет энхондрому с кости. В большинстве случаев костная пластика не требуется. Разрез ушивается, накладывается повязка.
Если же новообразование достигло больших размеров, приходится проводить резекцию кости. В этом случае требуется проведение костной пластики. Делают ее с помощью здоровой кости, взятой с другой конечности. Если костный дефект очень большой, проводится эндопротезирование.
При подозрении на злокачественную опухоль во время операции проводится срочное гистологическое исследование удаленных тканей. Если злокачественный характер подтверждается, объем операции расширяют и удаляют до 2 см внешне здоровой ткани. Это необходимо для профилактики рецидива опухоли.
Пациент находится в стационаре еще 10-14 дней – пока не снимут швы. Затем он переходит под наблюдение хирурга поликлиники. Срок восстановления после оперативного лечения занимает 1,5-2 месяца. Человеку рекомендуют:
- Соблюдение полноценной диеты с повышенным содержанием белка и кальция;
- Курс физиопроцедур;
- Курс массажа;
- Занятия лечебной гимнастикой;
- Медикаментозная терапия для устранения болевых ощущений и восстановления костной ткани.
Быстрее восстанавливаться после операции помогает отказ от вредных привычек, регулярные прогулки на свежем воздухе. Трудоспособность возвращается через месяц после оперативного вмешательства.
Рецидивирование энхондромы после хирургического лечения наблюдается у 10% пациентов. В таких случаях требуется повторная операция. При множественных энхондромах эффективного лечения не существует, оно проводится лишь симптоматически.
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