Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, Korea.
Clin Orthop Relat Res. 2014 Oct;472(10):3166-76. doi: 10.1007/s11999-014-3768-6. Epub 2014 Jul 8.
Studies have focused on intramedullary nailing of femoral simple bone cysts but have not clarified the recurrence frequency or management of recurrent cysts. In particular, the affect of pathologic fractures on cyst healing, recurrence, and complications of treatment have not been reported.
QUESTIONS/PURPOSES: We performed a retrospective comparative study to examine whether there were differences between simple bone cysts in the proximal femur nailed after pathologic fracture and those without pathologic fracture in terms of (1) healing time, (2) frequency and timing of recurrence, and (3) complications.
From 1995 to 2005, 54 patients diagnosed with femoral simple bone cysts were treated and followed for a minimum of 8 years. Flexible nails were inserted in a retrograde fashion in 25 patients with fractures and 29 patients without fractures. The healing period, degree of radiographic consolidation based on the criteria of Capanna et al., recurrence frequency, and final bony abnormalities were analyzed. The mean followups were 107 months (range, 96-124 months) and 103 months (range, 96-140 months) in the groups with and without fractures, respectively. With the numbers available, a post hoc calculation showed that this study had 80% power to detect a difference of 7 months of healing time as significant with a probability less than 0.05.
With the numbers available, the mean healing period was not different between groups (25 versus 30 months in the groups with and without fractures, respectively; p = 0.16). Complete healing was observed at 19 versus 18 months, incomplete healing at 5 versus 8 months, and recurrence was observed in one and three patients in the groups with and without fractures, respectively. No differences were found in the distribution of healing grade based on the criteria of Capanna et al. A second surgery was performed using intramedullary nails in two patients with an open physis and compression hip screw fixation was performed in two patients with a closed physis. Finally, the recurrent cysts were classified as completely healed in three patients and incompletely healed in one.
Whether a pathologic fracture had occurred before surgical treatment, intramedullary nailing of femoral simple bone cysts resulted in reliable healing, and the frequency of recurrence did not differ. Because this was a retrospective study, the optimal treatment for recurred cysts after intramedullary nailing should be further investigated through a comparative or prospective study.
已有研究聚焦于股骨单纯性骨囊肿的髓内钉治疗，但并未明确囊肿复发的频率或复发后如何处理。尤其是病理性骨折对囊肿愈合、复发和治疗并发症的影响，尚未有相关报道。
问题/目的：我们进行了一项回顾性对比研究，以检查股骨近端经病理性骨折后行髓内钉治疗的单纯性骨囊肿与未发生病理性骨折的单纯性骨囊肿之间是否存在差异，具体包括：（1）愈合时间；（2）复发的频率和时间；（3）并发症。
1995 年至 2005 年间，54 例股骨单纯性骨囊肿患者接受了治疗并随访至少 8 年。25 例骨折患者和 29 例无骨折患者采用逆行髓内钉固定。分析愈合时间、Capanna 等标准的放射学愈合程度、复发频率和最终的骨骼异常。骨折组和无骨折组的平均随访时间分别为 107 个月（范围：96-124 个月）和 103 个月（范围：96-140 个月）。根据现有数量进行的事后计算显示，本研究有 80%的把握力检测到 7 个月的愈合时间差异有统计学意义（概率小于 0.05）。
根据现有数量，两组的平均愈合时间无差异（骨折组和无骨折组分别为 25 个月和 30 个月；p=0.16）。19 个月时观察到完全愈合，18 个月时观察到不完全愈合，骨折组和无骨折组分别有 1 例和 3 例患者复发。根据 Capanna 等的标准，愈合等级的分布无差异。两名骺板未闭合的患者采用髓内钉进行二次手术，两名骺板已闭合的患者采用加压髋螺钉固定。最终，3 例复发性囊肿完全愈合，1 例不完全愈合。
无论手术前是否发生病理性骨折，股骨单纯性骨囊肿的髓内钉治疗均可获得可靠的愈合，且复发率无差异。由于这是一项回顾性研究，需要通过对比或前瞻性研究进一步探讨髓内钉治疗后复发囊肿的最佳治疗方法。
