Gava Nelson Fabrício, Engel Edgard Eduard
Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Clinical Hospital, Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes avenue, 11th floor, 14040-030, Ribeirão Preto, São Paulo, Brazil.
Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Clinical Hospital, Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes avenue, 11th floor, 14040-030, Ribeirão Preto, São Paulo, Brazil.
Orthop Traumatol Surg Res. 2022 Jun;108(4):102966. doi: 10.1016/j.otsr.2021.102966. Epub 2021 May 24.
Benign and pseudo-neoplastic bone lesions are usually treated by curettage and filling of the cavity. This filling is usually achieved with the use of autologous bone grafts, bone cement, allografts, xenografts, or synthetic bone substitutes. Recently, some authors have suggested that these defects do not require filling for consolidation but the respective rate of complications of each method is not well defined. Therefore, we did a systematic review aiming to answer: (1) Not filling bone cavities after benign bone tumour curettage may increase the rate of fractures? (2) Can the volume of the bone defect in itself be a specific or reliable predictor of fracture? (3) Does the mean functional outcome, recurrence, non-weight bearing time, other postoperative complications or bone consolidation time vary between the methods of filling?
The PubMed (2407 articles) and Latin American and Caribbean Health Sciences Literature (LILACS) (50 articles) databases were reviewed, without restriction considering publication date. After exclusion criteria, 62 articles were selected for data collection. Filling or not filling (UN), methods of filling, fracture rate, bone defect size, mean functional outcome, recurrence, non-weight bearing time, other postoperative complications, consolidation time were the data of interest.
The number of patients was 2555 distributed among the different filling methods. Unfilled cavities were associated with higher fracture rate [20/302 (6.62%)] versus 4/189 (2.12%) for allografts, 14/343 (4.08%) for cement filling, 4/247 for autograft (1.62%), and 12/580 (2.07%) for bone substitute. The volume of the bone defect alone is not a specific or reliable predictor of fracture. All filling methods were similar regarding the mean functional outcome, recurrence rate and consolidation time. The bone cement allowed early weight bearing time (mean of weeks): UN: 9.67; autologous bone grafts: 9.8; bone cement: 0.5; allografts: 9.0; synthetic bone substitutes: 9.96.
Not filling the bone cavity after benign bone tumour curettage is an alternative, but can increase fracture rate, even in small volume bone defects. The use of prophylactic fixation drastically reduces the fracture rate. Filling with cement reduces weight bearing time. There are little differences between the methods used to fill, even compared to not filling the cavity.
III; systematic review.
良性和假性肿瘤性骨病变通常通过刮除和填充骨腔来治疗。这种填充通常使用自体骨移植、骨水泥、同种异体骨移植、异种骨移植或合成骨替代物来实现。最近，一些作者认为这些骨缺损无需填充即可实现骨愈合，但每种方法的并发症发生率尚未明确界定。因此，我们进行了一项系统评价，旨在回答以下问题：（1）良性骨肿瘤刮除术后不填充骨腔是否会增加骨折发生率？（2）骨缺损的体积本身是否是骨折的特异性或可靠预测指标？（3）不同填充方法之间的平均功能结局、复发率、非负重时间、其他术后并发症或骨愈合时间是否存在差异？
检索了PubMed（2407篇文章）和拉丁美洲及加勒比地区健康科学文献数据库（LILACS）（50篇文章），检索时不考虑发表日期。经过排除标准筛选后，选取62篇文章进行数据收集。填充或不填充（UN）、填充方法、骨折发生率、骨缺损大小、平均功能结局、复发率、非负重时间、其他术后并发症、骨愈合时间是感兴趣的数据。
2555例患者分布于不同的填充方法中。未填充骨腔的骨折发生率较高[20/302（6.62%）]，而异种骨移植为4/189（2.12%），骨水泥填充为14/343（4.08%），自体骨移植为4/247（1.62%），骨替代物为12/580（2.07%）。单纯骨缺损的体积不是骨折的特异性或可靠预测指标。所有填充方法在平均功能结局、复发率和骨愈合时间方面相似。骨水泥允许早期负重时间（平均周数）：未填充：9.67；自体骨移植：9.8；骨水泥：0.5；异种骨移植：9.0；合成骨替代物：9.96。
良性骨肿瘤刮除术后不填充骨腔是一种选择，但即使在小体积骨缺损中也会增加骨折发生率。使用预防性内固定可显著降低骨折发生率。骨水泥填充可缩短负重时间。即使与不填充骨腔相比，不同填充方法之间也几乎没有差异。
III级；系统评价。
