Deventer Niklas, Deventer Nils, Gosheger Georg, de Vaal Marieke, Vogt Bjoern, Budny Tymoteusz
Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
Department of Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
J Bone Oncol. 2021 Jul 20;30:100384. doi: 10.1016/j.jbo.2021.100384. eCollection 2021 Oct.
This review of the literature aims to compare the etiology, the pathogenesis, the clinical diagnostics and the relevant treatment options of two different types of cystic bone lesions: the solitary bone cyst (SBC) and the aneurysmal bone cyst (ABC). Whereas the clinical symptoms and the radiographic appearance can be similar, the diagnostic pathway and the treatment options are clearly different. The solitary bone cyst (SBC) represents a tumor-like bone lesion, occurring most frequently in the humerus and femur in children and adolescents. Pain caused by intercurrent pathological fractures is often the first symptom, and up to 87% of the cysts are associated with pathological fractures. In the majority of cases SBCs can be treated conservatively, especially in the upper extremity. However, if a fracture is completely dislocated, joint affecting, unstable or open, surgical treatment is necessary. Pain under weight bearing or regaining the ability to mobilize after fracture timely can necessitate surgical treatment in SBCs affecting the lower extremity. Spontaneous resolution can be seen in rare cases. The aneurysmal bone cyst (ABC) is a benign, locally aggressive tumor that occurs in childhood and early adulthood. It usually affects the metaphysis of long bones but can also occur in the spine or the pelvis. ABC can be primary but also secondary to other bone pathologies. The diagnosis has to be confirmed by biopsy and histopathological examinations. With cytogenetic studies and the detection of specific translocations of the ubiquitin-specific protease (USP) 6 gene primary ABCs can be differentiated from secondary ABCs and other bone lesions. Among various modalities of treatment i.e. en bloc resection, intralesional curettage with adjuvants, embolization or the systemic application of denosumab, intralesional sclerotherapy using polidocanol is an effective and minimally invasive treatment of primary ABCs.
孤立性骨囊肿（SBC）和动脉瘤样骨囊肿（ABC）的病因、发病机制、临床诊断及相关治疗方案。尽管临床症状和影像学表现可能相似，但诊断途径和治疗方案明显不同。孤立性骨囊肿（SBC）是一种肿瘤样骨病变，最常见于儿童和青少年的肱骨和股骨。并发病理性骨折引起的疼痛通常是首发症状，高达87%的囊肿与病理性骨折有关。在大多数情况下，SBC可采用保守治疗，尤其是在上肢。然而，如果骨折完全脱位、影响关节、不稳定或开放性骨折，则需要手术治疗。影响下肢的SBC在负重时疼痛或骨折后及时恢复活动能力可能需要手术治疗。罕见情况下可见自发消退。动脉瘤样骨囊肿（ABC）是一种良性、局部侵袭性肿瘤，发生于儿童期和成年早期。它通常影响长骨的干骺端，但也可发生于脊柱或骨盆。ABC可以是原发性的，也可以继发于其他骨病变。诊断必须通过活检和组织病理学检查来证实。通过细胞遗传学研究和泛素特异性蛋白酶（USP）6基因特定易位的检测，原发性ABC可与继发性ABC及其他骨病变相鉴别。在各种治疗方式中，即整块切除、病灶内刮除并辅以辅助治疗、栓塞或地诺单抗的全身应用，使用聚多卡醇进行病灶内硬化治疗是原发性ABC的一种有效且微创的治疗方法。
