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"etiology": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Опухоли развиваются из участков хряща, расположенных в местах, где в норме хрящевая ткань отсутствует. Исследователи выяснили, что гетеротопическая локализация хряща является следствием нарушения процесса окостенения во внутриутробном периоде и в первые годы жизни ребенка. Непосредственная причина нарушения окостенения пока не выяснена, однако установлено, что эта патология не связана с воздействием вредных веществ или радиации. Предполагается, что рост энхондромы из гетеротопически расположенного участка хряща провоцируется травматическими поражениями и воспалительными процессами в костной ткани.</span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Опухоль представляет собой зрелый гиалиновый хрящ с утраченной структурой. В отличие от нормального хряща клетки энхондромы расположены хаотично, их размер и форма могут сильно различаться. Неоплазия покрыта надхрящницей и имеет дольчатое строение. Внутри обычно образуются небольшие очаги окостенения. Характерны дистрофические изменения ткани, проявляющиеся разжижением межклеточного вещества и формированием кист. При малигнизации клетки опухоли становятся более крупными, увеличивается количество клеток с двумя ядрами.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">«Излюбленная» локализация энхондром – короткие трубчатые кости стоп и кистей. Возможно также поражение плечевой и бедренной кости. В области других длинных костей единичные энхондромы встречаются редко. Иногда поражаются плоские кости: кости таза, лопатка и т. д. При множественном хондроматозе (болезни Олье) опухоли могут выявляться в области одной половины тела (правой или левой) или в области одной конечности. Реже патологический процесс распространяется на обе нижние конечности.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В целях постановки диагноза достаточно провести рентгенографическое исследование кости. На рентгеновском изображении об опухолевом процессе будут свидетельствовать очаги просветления в костном массиве. Непосредственно в области светлого пятна нередко определяются точечные или кольцевидные участки затемнения, которые указывают на обызвествление в самой опухоли (выпадение солей кальция). Диагностика может быть проведена посредством обычного рентгена. Однако более точной методикой с целью обнаружения энхондром признана компьютерная томография.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Помимо рентгенологического или КТ обследования, обязательным является прохождение магниторезонансной томографии. МРТ необходима для глубинной оценки состояния мягких тканей, расположенных поблизости с атипичным образованием. При подозрении на злокачественность аномального внутрикостного хряща пациенту будет произведена процедура биопсии с целью гистологического исследования взятого биоптата. Биопсию проводят из разных зон очага, поскольку на ранней ступени злокачественные ткани могут чередоваться с доброкачественными.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Тактика лечения зависит от локализации новообразования. Опухоли коротких трубчатых костей не склонны к малигнизации, поэтому при таком расположении энхондромы возможно динамическое наблюдение, включающее в себя регулярные осмотры и повторную рентгенографию пораженного сегмента. Из-за потенциальной опасности озлокачествления энхондром длинных трубчатых и плоских костей специалисты в области клинической онкологии обычно предлагают пациентам удалять опухоль сразу после постановки диагноза.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Растущие энхондромы коротких трубчатых костей иссекают в пределах здоровых тканей. При образовании крупных дефектов используют гомо- или аллотрансплантаты. При опухолях плоских и длинных трубчатых костей необходимо расширенное хирургическое вмешательство – сегментарная резекция кости с последующим замещением дефекта.</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактические мероприятия не разработаны.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Симптоматика появляется обычно при значительном увеличении объемов энхондромы. По мере роста она начинает давить на соседние ткани, по этой причине возникают болезненные ощущения в районе сосредоточения очага и деформации. Итак, конкретизируем возможные жалобы пациента с подобной картиной заболевания:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">постоянный локальный болевой синдром легкой/средней интенсивности, свидетельствующий о раздражении нервных стволов, компрессии сосудов;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">умеренная боль в области поражения в ночное время суток (нарастающая и сильная боль – тревожный знак, который может указывать на злокачественные процессы);</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">видимая деформация в виде утолщения и/или возвышения на ограниченном участке кости конечности;</span></li>\r\n<li style=\"list-style-type: disc; font-size: 9.5pt; font-family: Verdana; color: #313e48; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">при близком расположении хрящевой неоплазии с суставом не исключены артралгии, синовиты, опорно-двигательные дисфункции суставного аппарата;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 9.5pt; font-family: Verdana; color: #313e48; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">спонтанные переломы костей.</span></p>\r\n</li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Энхондромы способны не только деформировать кость, которую в буквальном смысле раздувают изнутри, но и к снижению плотности костной ткани. Наиболее встречаемое последствие – внезапное нарушение целостности кости, происходящее либо вовсе без причины, либо вследствие даже самой незначительной травмы. Такие переломы сопровождаются появлением резкой сильной боли в месте костного разлома, крепитацией, нестабильностью поврежденной кости, искривлением конечности.</span></p>",
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