Mavčič Blaž, Saraph Vinay, Gilg Magdalena M, Bergovec Marko, Brecelj Janez, Leithner Andreas
Department of Orthopaedic Surgery, Faculty of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Division of Pediatric Orthopaedics.
J Pediatr Orthop B. 2019 Jan;28(1):51-56. doi: 10.1097/BPB.0000000000000518.
Treatment of unicameral bone cysts (UBC) in the humerus with drainage screws is scarcely reported in the literature. The aim of this retrospective study was to compare drainage screws and alternative treatment methods with respect to the number of required surgical procedures to achieve sufficient UBC healing, postoperative fractures/recurrences/complications, and radiological outcome. Medical archives of two tertiary orthopedic referral centers were screened for all patients who were treated surgically for humeral UBC in the period 1991-2015 with a histologically/cytologically confirmed diagnosis. Sex, age, all surgical procedures, fractures, complications, recurrences, and the final radiological outcome were compared between patients treated with drainage screws, elastic intramedullary nails, or curettage with optional grafting. The study included 106 operated patients with a mean age of 10.3 years, with a mean follow-up of 5.7 years. The average number of UBC-related surgical procedures in sex-matched and age-matched treatment groups was 2.7 with drainage screws, 2.8 with intramedullary nails, and 3.5 with curettage/grafting (P=0.54). Intramedullary nails (odds ratio 0.20) and older age (odds ratio for each year 0.83) predicted a lower risk of postoperative UBC recurrence. Patients with drainage screws had the highest UBC recurrence rates and the lowest rates of changed initial treatment method. There was no difference between the treatment groups in the postoperative fracture rate, complications, or the final radiological outcome. UBC treatment in the humerus therefore requires approximately three surgical procedures, irrespective of the treatment modality chosen. Adding an elastic intramedullary nail to a humeral UBC cyst may reduce recurrence risk and prevent further fractures. Level of Evidence: Level III - therapeutic retrospective comparative study.
文献中鲜有关于使用引流螺钉治疗肱骨单房骨囊肿（UBC）的报道。本回顾性研究的目的是比较引流螺钉与其他治疗方法在实现UBC充分愈合所需的手术次数、术后骨折/复发/并发症以及影像学结果方面的差异。对两个三级骨科转诊中心的医疗档案进行筛查，选取1991年至2015年期间接受手术治疗且经组织学/细胞学确诊为肱骨UBC的所有患者。比较接受引流螺钉、弹性髓内钉或刮除术加选择性植骨治疗的患者的性别、年龄、所有手术操作、骨折、并发症、复发情况以及最终影像学结果。该研究纳入了106例接受手术的患者，平均年龄为10.3岁，平均随访时间为5.7年。在性别和年龄匹配的治疗组中，与UBC相关的平均手术次数在引流螺钉组为2.7次，髓内钉组为2.8次，刮除术/植骨组为3.5次（P = 0.54）。髓内钉（优势比0.20）和年龄较大（每年优势比0.83）预示术后UBC复发风险较低。使用引流螺钉的患者UBC复发率最高，初始治疗方法改变率最低。治疗组在术后骨折率、并发症或最终影像学结果方面无差异。因此，无论选择何种治疗方式，肱骨UBC的治疗大约都需要三次手术。在肱骨UBC囊肿中添加弹性髓内钉可能会降低复发风险并预防进一步骨折。证据级别：III级——治疗性回顾性比较研究。
