Eyesan S U, Ugwoegbulem O A, Obalum D C
Department of Orthopaedic, National Orthopaedic Hospital, Igbobi, Lagos Nigeria.
Niger J Clin Pract. 2009 Dec;12(4):367-70.
Cystic bony defects are characteristics of bone tumours especially benign ones e.g. Giant cell tumours of bone [GCT] and some metastatic tumours to bone. These patients present late with significant cystic cavities at a time the cost and availability of prosthetic implants to replace these defects sometimes precludes resection. The objective of this study is to evaluate the outcome of filling these defects with bone cement augmented with plate and screw for stability.
A seven year prospective study was carried out in patients presenting with large cystic bony defects secondary to bone tumours at the oncology unit of the National Orthopaedic Hospital, Igbobi, Lagos. Data such as age, sex, anatomic location of lesions, histological type of tumours, x-ray findings, operation performed with the number of packets of bone cement used to fill the resultant bony defects were retrieved from prepared proforma. The average follow-up was 36 months.
The proximal tibia and distal femur accounted for 42.9% and 28.6% respectively of the 14 patients studied. Giant cell tumour was the most common histological diagnosis 78.6%. Bone cement was effective in meeting the local requirements of limb salvage, early functional recovery and as a temporising measure until the patients can avail themselves of better options. The complication encountered was that of anaphylactic reaction in 2 scrub nurses.
Bone cement augmented with appropriate implants has proven valuable as a stop gap in filling large cystic bony defects resulting from tumours.
囊性骨缺损是骨肿瘤尤其是良性骨肿瘤(如骨巨细胞瘤[GCT])以及一些骨转移瘤的特征。这些患者就诊时较晚,此时存在明显的囊性空洞,而用于替代这些缺损的假体植入物的成本和可得性有时会妨碍进行切除手术。本研究的目的是评估用钢板和螺钉增强的骨水泥填充这些缺损以实现稳定的效果。
在拉各斯伊格博比国立骨科医院肿瘤科,对患有骨肿瘤继发大囊性骨缺损的患者进行了为期七年的前瞻性研究。从预先准备的表格中获取年龄、性别、病变的解剖位置、肿瘤的组织学类型、X线检查结果、所施行的手术以及用于填充最终骨缺损的骨水泥包数等数据。平均随访时间为36个月。
在所研究的14例患者中,胫骨近端和股骨远端分别占42.9%和28.6%。骨巨细胞瘤是最常见的组织学诊断类型,占78.6%。骨水泥在满足保肢的局部需求、促进早期功能恢复以及作为一种临时措施直至患者能够获得更好的选择方面是有效的。所遇到的并发症是2名 scrub护士发生过敏反应。
用适当植入物增强的骨水泥已被证明在填充肿瘤导致的大囊性骨缺损方面作为权宜之计具有价值。