Wilke Benjamin, Houdek Matthew, Rao Rameshwar R, Caird Michelle S, Larson A Noelle, Milbrandt Todd
Orthopedics. 2017 Sep 1;40(5):e862-e867. doi: 10.3928/01477447-20170810-01. Epub 2017 Aug 18.
Little data exist to guide the treatment of unicameral bone cysts in the proximal femur. Methods of treatment include corticosteroid injections, curettage and bone grafting, and internal fixation. The authors completed a multi-institutional, retrospective review to evaluate their experience with proximal femoral unicameral bone cysts. They posed the following questions: (1) Does internal fixation reduce the risk of further procedures for the treatment of a unicameral bone cyst? (2) Is radiographic healing faster with internal fixation? Following institutional review board approval, the authors conducted a retrospective review of 36 patients treated for a unicameral bone cyst of the proximal femur at their institutions between 1974 and 2014. Medical records and radiographs were reviewed to identify patient demographics and treatment outcomes. Tumor locations included femoral neck (n=13), intertrochanteric (n=16), and subtrochanteric (n=7). Initial treatment included steroid injection (n=2), curettage and bone grafting (n=9), and internal fixation with curettage and bone grafting (n=25). Mean time was 9 months to radiographic healing and 15 months to return to full activity. The number of patients requiring additional surgeries was increased among those who did not undergo internal fixation. There was no difference in time to radiographic healing. However, time to return to normal activities was reduced if patients had received internal fixation. A significant reduction in additional procedures was observed when patients had been treated with internal fixation. Although this did not influence time to radiographic healing, patients did return to normal activities sooner. Internal fixation should be considered in the treatment of proximal femoral unicameral bone cysts. [Orthopedics. 2017; 40(5):e862-e867.].
目前几乎没有数据可用于指导股骨近端单房性骨囊肿的治疗。治疗方法包括皮质类固醇注射、刮除植骨和内固定。作者完成了一项多机构回顾性研究，以评估他们治疗股骨近端单房性骨囊肿的经验。他们提出了以下问题：（1）内固定是否能降低单房性骨囊肿进一步治疗的风险？（2）内固定是否能使影像学愈合更快？在获得机构审查委员会批准后，作者对1974年至2014年间在其机构接受股骨近端单房性骨囊肿治疗的36例患者进行了回顾性研究。查阅病历和X光片以确定患者人口统计学特征和治疗结果。肿瘤位置包括股骨颈（n = 13）、转子间（n = 16）和转子下（n = 7）。初始治疗包括类固醇注射（n = 2）、刮除植骨（n = 9）以及内固定联合刮除植骨（n = 25）。影像学愈合的平均时间为9个月，恢复完全活动的平均时间为15个月。未接受内固定的患者中需要额外手术的人数增加。影像学愈合时间没有差异。然而，如果患者接受了内固定，恢复正常活动的时间会缩短。接受内固定治疗的患者额外手术次数显著减少。虽然这并未影响影像学愈合时间，但患者确实能更快恢复正常活动。治疗股骨近端单房性骨囊肿时应考虑内固定。[《骨科》。2017；40（5）：e862 - e867。]
