Journeau P, Ciotlos D
Service de Chirurgie Orthopédique Pédiatrique (Pr Lascombes), CHU de Nancy, Hôpital d'Enfants, 5, allée du Morvan, 54511 Vandoeuvre.
Rev Chir Orthop Reparatrice Appar Mot. 2003 Jun;89(4):333-7.
Several methods are used to treat essential bone cysts in children: curettage with bone graft, simple drainage, steroid injection, intramedullary nailing. No one method is preferred by all. We compared two retrospective series of children with solitary bone cysts treated by steroid injection or intramedullary nailing.
Seventy-two cysts were treated by the same team: 54 by injection of methylprednisolone, and 18 by intramedullary nailing. Fifty cysts were disclosed by bone fracture. The others were revealed by pain or discovered fortuitously. Seventy-five percent of the patients were boys. The humerus was involved in two-thirds of the cases. Patient age ranged from 5 to 10 years. Intramedullary nailing was used for the femur in 10 cases and the humerus for 8. Steroid injections were given after cyst opacification using 160 mg per injection, total mean dose 800 mg (range 80-2400 mg).
Cure was obtained at 4 years on the average, with no difference between the two series. Complications observed were transient or definitive and more severe in patients treated by steroid injections. Most of the complications were transient effects of steroid overdosage or limb length discrepancy: 7 shortenings (1-8 cm) for injected cysts (all in patients given > 100 mg methylprednisolone), compared with 2 shortenings<2 cm after intramedullary nailing.
Steroid injections have been used for many years with variable results depending on the reported series. Cyst opacification before injection is recommended to identify anomalies which could compromise outcome. Strict compliance with the rules of steroid treatment is required to avoid complications, as observed in our patients, which are dose dependent. The percutaneous method is attractive but can be used with other products such as bone marrow or bone substitutes to optimize results. Intramedullary nailing has the advantage of providing immediate support of the damaged bone while allowing cyst drainage and evacuation of the lytic segments. This method should probably be preferred for weight-bearing segments whether the cyst is associated with fracture or not. For non-weight-bearing segments, the choice between percutaneous treatment, and the substance to use, and intramedullary nailing depends largely on bone quality.
有多种方法用于治疗儿童原发性骨囊肿：刮除植骨、单纯引流、类固醇注射、髓内钉固定。没有一种方法受到所有人的青睐。我们比较了两组回顾性研究系列，一组是接受类固醇注射治疗的儿童孤立性骨囊肿患者，另一组是接受髓内钉固定治疗的患者。
同一团队治疗了72例囊肿：54例通过注射甲泼尼龙治疗，18例通过髓内钉固定治疗。50例囊肿因骨折而被发现，其他的则因疼痛或偶然发现。75%的患者为男孩。三分之二的病例累及肱骨。患者年龄在5至10岁之间。10例股骨和8例肱骨采用髓内钉固定。在囊肿显影后进行类固醇注射，每次注射160mg，平均总剂量800mg（范围80 - 2400mg）。
平均4年时获得治愈，两组之间无差异。观察到的并发症有短暂性或永久性的，在接受类固醇注射治疗的患者中更严重。大多数并发症是类固醇过量的短暂影响或肢体长度差异：注射治疗的囊肿中有7例缩短（1 - 8cm）（所有患者接受的甲泼尼龙剂量>100mg），而髓内钉固定后有2例缩短<2cm。
类固醇注射已使用多年，根据报道的系列研究结果各不相同。建议在注射前使囊肿显影，以识别可能影响治疗结果的异常情况。如我们的患者所示，为避免并发症，需要严格遵守类固醇治疗规则，并发症与剂量相关。经皮方法很有吸引力，但可以与其他产品如骨髓或骨替代物一起使用以优化结果。髓内钉固定的优点是能立即为受损骨骼提供支撑，同时允许囊肿引流并清除溶解部分。无论囊肿是否与骨折相关，对于负重部位，这种方法可能更受青睐。对于非负重部位，经皮治疗、使用的物质以及髓内钉固定之间的选择很大程度上取决于骨质。
