Glaser D L, Dormans J P, Stanton R P, Davidson R S
Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, PA, USA.
Clin Orthop Relat Res. 1999 Mar(360):231-7. doi: 10.1097/00003086-199903000-00027.
Unicameral bone cysts are not seen commonly in the calcaneus. Little is known about the etiology and natural history of these lesions. Calcaneal cysts often are symptomatic, although some of these lesions are detected as incidental findings. Treatment has been advocated based on the fear of pathologic fracture and collapse. Several published series have been divided in their favor for either open treatment or injection management. These series are small, and the optimal treatment is still in question. The current study compared the efficacy of methylprednisolone acetate injection treatment with curettage and bone grafting in the treatment of unicameral bone cysts of the calcaneus. All patients treated for unicameral bone cysts of the calcaneus during the past 7 years at two institutions were reviewed. Eleven patients met inclusion criteria. All diagnoses were confirmed radiographically or histologically. Demographic information, presenting complaints, diagnostic imaging, treatment modalities, and outcome were analyzed. Long term radiographic and subjective followup was obtained. Eighteen surgical procedures were performed on 11 patients with 12 cysts. Nine injections performed on six patients failed to show healing of the cyst. Nine cysts treated with curettage and bone grafting showed cyst healing. At mean followup of 28 months (range, 12-77 months), all 11 patients had no symptoms; there were no recurrences of the cyst in the nine patients who underwent bone grafting and persistence of the cyst in the two patients who underwent injection therapy. This review reports one of the largest series of cysts in this location. The results indicate that steroid injection treatment, although useful in other locations, may not be the best option for the management of unicameral bone cysts in the calcaneus. Curettage and bone grafting yielded uniformly good results.
单纯性骨囊肿在跟骨中并不常见。人们对这些病变的病因和自然史了解甚少。跟骨囊肿通常有症状，尽管其中一些病变是偶然发现的。基于对病理性骨折和塌陷的担忧，人们主张进行治疗。已发表的几个系列研究在开放治疗或注射治疗的支持方面存在分歧。这些系列研究规模较小，最佳治疗方法仍存在疑问。本研究比较了醋酸甲泼尼龙注射治疗与刮除植骨术治疗跟骨单纯性骨囊肿的疗效。回顾了过去7年在两家机构接受跟骨单纯性骨囊肿治疗的所有患者。11名患者符合纳入标准。所有诊断均经影像学或组织学证实。分析了人口统计学信息、主诉、诊断性影像学、治疗方式和结果。获得了长期的影像学和主观随访结果。对11例患者的12个囊肿进行了18次手术。对6例患者进行的9次注射未能显示囊肿愈合。9个接受刮除植骨术治疗的囊肿显示囊肿愈合。平均随访28个月（范围12 - 77个月），所有11例患者均无症状；接受植骨术的9例患者囊肿无复发，接受注射治疗的2例患者囊肿持续存在。本综述报道了该部位最大系列的囊肿之一。结果表明，类固醇注射治疗虽然在其他部位有用，但可能不是跟骨单纯性骨囊肿治疗的最佳选择。刮除植骨术取得了一致的良好效果。
