Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
Department of Orthopedic Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, 503-8502, Japan.
J Orthop Surg Res. 2018 Jul 5;13(1):168. doi: 10.1186/s13018-018-0869-z.
Endoscopic curettage is considered applicable for the treatment of simple bone cysts with the expectation that it might be less invasive than open curettage. In this study, we investigated the efficacy of endoscopic curettage for the treatment of simple bone cysts. The goal was to investigate the incidence of cyst recurrence and bone healing after endoscopic curettage. Moreover, complications and functionality at the final follow-up were evaluated.
From 2003 to 2014, 37 patients with simple bone cysts underwent endoscopic curettage. Twenty-four were male and 13 were female, with a mean age of 14.7 years. Endoscopic curettage was performed with the support of an arthroscope via 7-8 mm holes penetrated by cannulated drills with a small incision. The cysts underwent curettage using angled curettes, rongeurs, and an electrical shaver until the normal bone was observed in the medullary cavity. To investigate the bone healing after endoscopic curettage, we evaluated the consolidation of the cyst at the final evaluation (Modified Neer Classification) and the time to solid union after operation, which was defined as the sufficient thickness of the cortical bone to prevent fracture and allow physical activities.
Recurrence occurred in seven patients (18.9%). A log-rank analysis revealed that contact with the physis was associated with recurrence (p = 0.006). Among 31 patients (83.7%), the consolidation of cyst was considered healed at the final X-ray follow-up period, and in these patients, the mean time taken for solid union of cortical bone thinning was 4.0 months (standard deviation, 2.4). With regard to major complications of endoscopic curettage, a transient radial nerve palsy and two postoperative fractures occurred. The former problem was managed conservatively and the latter problems by transient internal fixation; these problems were managed without any further complications. All patients had a good postoperative function.
Endoscopic curettage might be a useful alternative as it is a minimally invasive procedure for the treatment of simple bone cysts. Considering the relatively smaller size of this study, further investigation should be necessary for deducing the reliable conclusion.
内镜刮除术被认为适用于治疗单纯性骨囊肿，因为它可能比开放性刮除术的创伤更小。在这项研究中，我们调查了内镜刮除术治疗单纯性骨囊肿的疗效。目的是研究内镜刮除术后囊肿复发和骨愈合的情况。此外，还评估了最终随访时的并发症和功能。
2003 年至 2014 年，37 例单纯性骨囊肿患者接受了内镜刮除术。24 例为男性，13 例为女性，平均年龄为 14.7 岁。内镜刮除术在关节镜的支持下通过 7-8mm 的孔进行，这些孔由带套管的钻头穿透，切口较小。用角度刮匙、咬骨钳和电锯对内镜下的囊肿进行刮除，直到在骨髓腔内观察到正常骨。为了研究内镜刮除术后的骨愈合情况，我们在最终评估时（改良 Neer 分类）评估了囊肿的愈合情况，以及术后骨愈合的时间，这定义为皮质骨的足够厚度，以防止骨折和允许进行体育活动。
7 例（18.9%）患者复发。对数秩分析显示，与骨骺接触与复发有关（p=0.006）。在 31 例（83.7%）患者中，最终 X 射线随访时囊肿的愈合被认为是愈合的，在这些患者中，皮质骨变薄的骨愈合的平均时间为 4.0 个月（标准差为 2.4）。内镜刮除术的主要并发症中，有 1 例暂时性桡神经麻痹和 2 例术后骨折。前者采用保守治疗，后者采用暂时性内固定治疗；这些问题均无进一步并发症。所有患者术后功能良好。
内镜刮除术可能是一种有用的替代方法，因为它是一种治疗单纯性骨囊肿的微创方法。考虑到这项研究的样本量较小，需要进一步的研究来得出可靠的结论。
