Döring Kevin, Puchner Stephan, Vertesich Klemens, Funovics Philipp T, Hobusch Gerhard, Sulzbacher Irene, Chiari Catharina, Windhager Reinhard
Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
Orthop Traumatol Surg Res. 2022 Jun;108(4):103095. doi: 10.1016/j.otsr.2021.103095. Epub 2021 Oct 1.
Aneurysmal bone cysts (ABC) are benign tumors mostly occurring in children and young adults. Different open and minimal invasive surgical approaches have been proposed for the treatment of ABCs and yet no consensus is defined to date. The aim of this study was to retrospectively review data of a large single center series of ABCs with patients treated by open curettage with or without filling of the cavity or en-bloc resection. Questions/purposes We asked: (1) What was the local recurrence rate of ABC after surgical treatment at our institution? (2) What were positive or negative predictors for local recurrence? (3) Was there a benefit from adjuvant burring, phenolization or filling, respectively? (4) Where there changes in recurrence free survival in different time periods of primary surgery?
By retrospective data analysis of the Vienna Bone and Soft Tissue Tumor Registry, 123 patients surgically treated for primary aneurysmal bone cysts were identified. After exclusion of 33 patients (27%) due to a postoperative follow up below one year, 90 patients who were treated for primary ABCs between 1986 and 2009 were evaluated. These included 50 males and 40 females with a mean age of 16 years (SD 10 years; range: 2 to 51 years). The mean follow-up was 99 months. (SD 72 months, range: 13 to 329 months) RESULTS: Curettage was performed in 84 patients, while 45 patients received adjuvant phenolization. Local recurrence occurred in 28 patients after a mean time of 16 months, with a corresponding local recurrence free survival (RFS) of 83% after one year, 77% after 2 years and 66% after 5 years. ABCs located in hands and feet (p=0.044) showed a superior RFS, while younger patients (p=0.001) displayed an inferior RFS. Regarding adjuvant surgical techniques, mechanical cavity burring (p=0.004) and filling with autologous cancellous bone graft (p=0.024) showed protective effects on RFS. Patients treated between 1986 and 1999 (n=47) had a higher RFS than patients treated between 2000 and 2009 (n=43, p=0.011), as surgeons and surgical indications changed over time.
Although curettage, burring, phenolization and reconstruction with bone grafts came with a relatively high risk of local recurrence, open surgery is still justified in aggressively growing ABCs of critical localizations.
IV; therapeutic study.
骨动脉瘤样囊肿（ABC）是一种主要发生于儿童和年轻人的良性肿瘤。目前已提出了不同的开放手术和微创手术方法来治疗ABC，但至今尚未达成共识。本研究的目的是回顾性分析一个大型单中心系列ABC患者的数据，这些患者接受了开放刮除术，伴或不伴空腔填充或整块切除。问题/目的我们提出以下问题：（1）在我们机构，手术治疗后ABC的局部复发率是多少？（2）局部复发的阳性或阴性预测因素有哪些？（3）辅助性打磨、酚化或填充分别是否有益？（4）初次手术不同时间段的无复发生存率有无变化？
通过对维也纳骨与软组织肿瘤登记处的回顾性数据分析，确定了123例接受原发性骨动脉瘤样囊肿手术治疗的患者。排除33例（27%）术后随访时间不足一年的患者后，对1986年至2009年间接受原发性ABC治疗的90例患者进行了评估。其中包括50例男性和40例女性，平均年龄16岁（标准差10岁；范围：2至51岁）。平均随访时间为99个月（标准差72个月，范围：13至329个月）。结果：84例患者接受了刮除术，45例患者接受了辅助性酚化治疗。28例患者出现局部复发，平均时间为16个月，相应的1年无局部复发生存率（RFS）为83%，2年为77%，5年为66%。位于手部和足部的ABC（p = 0.044）显示出较好的RFS，而年轻患者（p = 0.001）的RFS较差。关于辅助手术技术，机械性空腔打磨（p = 0.004）和自体松质骨移植填充（p = 0.024）对RFS有保护作用。1986年至1999年间治疗的患者（n = 47）比2000年至2009年间治疗的患者（n = 43，p = 0.011）有更高的RFS，因为外科医生和手术指征随时间发生了变化。
尽管刮除术、打磨、酚化和骨移植重建存在相对较高的局部复发风险，但对于关键部位侵袭性生长的ABC，开放手术仍然是合理的。
IV；治疗性研究。
