儿童单房性骨囊肿病理性骨折的即刻手术与延迟手术评估

Evaluation of immediate and delayed surgery for pathological fracture due to unicameral bone cysts in children.

作者信息

Chen Xin, Chen Kai, Su Yuxi

机构信息

Department of Radiology, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing, China.

Department II of Orthopedics; Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing, China.

出版信息

J Child Orthop. 2020 Aug 1;14(4):335-342. doi: 10.1302/1863-2548.14.200051.

DOI:10.1302/1863-2548.14.200051

PMID:32874368

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7453165/

Abstract

PURPOSE

Unicameral bone cysts (UBCs) are most often found when accompanied by a pathological fracture. In these cases, the doctor must determine the optimal timing for the surgery. The purpose of this study was to evaluate the outcome of immediate surgery as compared with delayed surgery in paediatric pathological fractures due to UBCs.

METHODS

This retrospective study assessed the medical records of 65 patients between January 2012 and September 2016. Group A included 34 patients who underwent immediate surgery, including curettage, demineralized bone matrix and fixation with elastic stable intramedullary nailing. Group B included 31 patients who underwent the same surgery several months later. The outcome evaluations included the radiological changes, brace fixation time, cyst healing time, at the first-, third- and sixth month, and final visit.

RESULTS

The mean brace fixation time was 26.3 days (sd 5.7) for group A and 53.8 days (sd .1) for group B (p = 0.012). According to radiological evaluations, 3/34 patients in group A and 5/31 in group B had recurrence after the first surgery. A second surgery was performed in all cases of recurrence, and all fractures were healed at the last visit. There was no significant difference in the recurrence rate between the two groups (p = 0.4631), and healing times were also similar (p = 0.6033).

CONCLUSION

Both the immediate and delayed surgery were safe for the treatment of UBCs with fractures. We suggest immediate surgery for shorter fixation time and early activity.

LEVEL OF EVIDENCE

IV.

摘要

目的

单房性骨囊肿（UBCs）最常在伴有病理性骨折时被发现。在这些情况下，医生必须确定最佳手术时机。本研究的目的是评估在因UBCs导致的儿童病理性骨折中，一期手术与延期手术的疗效比较。

方法

这项回顾性研究评估了2012年1月至2016年9月期间65例患者的病历。A组包括34例接受一期手术的患者，手术包括刮除、脱矿骨基质和弹性稳定髓内钉固定。B组包括31例在数月后接受相同手术的患者。疗效评估包括在第1、3和6个月以及末次随访时的影像学变化、支具固定时间、囊肿愈合时间。

结果

A组平均支具固定时间为26.3天（标准差5.7），B组为53.8天（标准差11.1）（p = 0.012）。根据影像学评估，A组34例患者中有3例、B组31例患者中有5例在首次手术后复发。所有复发病例均进行了二次手术，所有骨折在末次随访时均愈合。两组复发率无显著差异（p = 0.4631），愈合时间也相似（p = 0.6033）。