肱骨单房性骨囊肿：治疗结果
Unicameral Bone Cysts in the Humerus: Treatment Outcomes.
作者信息
Kadhim Muayad, Sethi Samir, Thacker Mihir M
机构信息
*Department of Orthopaedic Surgery, Nemours-Alfred I. DuPont Hospital for Children, Wilmington, DE †Thomas Jefferson University, Philadelphia, PA.
出版信息
J Pediatr Orthop. 2016 Jun;36(4):392-9. doi: 10.1097/BPO.0000000000000462.
BACKGROUND
Several treatment modalities have been described for the treatment of unicameral bone cysts (UBC). The aim of this study was to examine the outcome of various treatment modalities of UBC in a specific anatomic location, the humerus.
METHODS
This study is a retrospective case-only study of patients with humeral UBC with minimum follow-up of 1 year. Medical records and radiographs were assessed and UBC healing status was determined based on most recent follow-up radiographs and divided into 3 groups (healed, partially healed, and not healed). Descriptive statistics were utilized to summarize study outcome.
RESULTS
Sixty-eight patients (54 boys and 14 girls) with humeral UBC comprised the study population. Sixty-four cases (94.1%) presented with a pathologic fracture. Fifty-one cases were in the proximal metaphysis and 17 were in the diaphysis. Mean age at diagnosis was 9.2±3.7 years, and mean follow-up was 4.0±2.6 years. Twenty-five patients were treated with observation, 38 by injection (27 with steroids and 11 with bone marrow), and 5 by open surgery. Patients who underwent open surgery had relatively larger cyst length, width, and cyst index, and all healed or partially healed at last follow-up. UBC persistence was observed in 29% of diaphyseal and 27.5% of metaphyseal cysts. Of the 19 patients with persistence, 8 were treated with observation, 9 with steroid injection, and 2 with bone marrow injection. Inner wall disruption before injection was performed in 17 patients (24% did not heal), whereas 21 patients did not have inner wall disruption (33% did not heal). Twenty patients received >1 injection. Eleven patients complained of pain at the last visit (8 had a persistent cyst, 2 were partially healed, and 1 had a healed UBC).
CONCLUSIONS
Complete healing of humeral UBC is challenging to achieve irrespective of treatment modality. UBCs treated with open surgery tended to heal better. Unhealed cysts were more likely to be associated with pain.
LEVEL OF EVIDENCE
Level III-a retrospective comparative study.
背景
已描述了多种用于治疗单房性骨囊肿（UBC）的治疗方式。本研究的目的是在特定解剖部位（肱骨）检查UBC各种治疗方式的结果。
方法
本研究是一项针对肱骨UBC患者的回顾性单病例研究，最短随访时间为1年。评估病历和X线片，并根据最近的随访X线片确定UBC愈合状态，分为3组（愈合、部分愈合和未愈合）。采用描述性统计来总结研究结果。
结果
68例肱骨UBC患者（54例男性和14例女性）构成研究人群。64例（94.1%）出现病理性骨折。51例位于近端干骺端，17例位于骨干。诊断时的平均年龄为9.2±3.7岁，平均随访时间为4.0±2.6年。25例患者接受观察治疗，38例接受注射治疗（27例使用类固醇，11例使用骨髓），5例接受开放手术。接受开放手术的患者囊肿长度、宽度和囊肿指数相对较大，最后一次随访时均愈合或部分愈合。骨干囊肿和干骺端囊肿分别有29%和27.5%持续存在。在19例持续存在的患者中，8例接受观察治疗，9例接受类固醇注射，2例接受骨髓注射。17例患者在注射前进行了内壁破坏（24%未愈合），而21例患者未进行内壁破坏（33%未愈合）。20例患者接受了>1次注射。11例患者在最后一次就诊时抱怨疼痛（8例有持续囊肿，2例部分愈合，1例UBC已愈合）。
结论
无论采用何种治疗方式，肱骨UBC的完全愈合都具有挑战性。接受开放手术治疗的UBC愈合倾向更好。未愈合的囊肿更可能与疼痛相关。
证据水平
III级——回顾性比较研究。
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