Wang Yichen, Ren Xiang, Yang Dan, Fan Feilong, Shen Yang
Department of Orthopedics, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Radiology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Transl Pediatr. 2022 Jul;11(7):1261-1266. doi: 10.21037/tp-22-290.
Simple bone cysts (SBCs) are common osteolytic lesions in children, which often lead to pathological fractures of the non-weight-bearing bone (humerus) in patients. Cyst index is a classic index to evaluate the risk of pathological fracture, but the reliability of this index is reduced due to the deviation of cyst area in the frontal and lateral position and the subjectivity of the determination of cyst area. MRI can clearly show the cyst boundary, the appointment cycle is long, and children need to be examined under sedation, which cannot be judged by clinicians in time. Therefore, it is necessary to find a basic and simple imaging evaluation index in clinic. The purpose of this study is to retrospectively analyze the risk factors of pathological fracture of simple bone cyst of humerus in children.
The medical records and plain films of patients with SBCs from January 2014 to December 2021 were retrospectively analyzed. Patients were divided into a fracture group (35 cases) and a non-fracture group (10 cases). The relationship between pathological fractures and the children's age, gender, and cyst index was analyzed. The presence of the pectoralis major and the link to the tendon insertion site of ectopectoralis and anconeus lateralis (TEAL) of the lesion were also examined. Perform binary logistic regression analysis.
Binary logistic regression analysis was performed on the age, gender, and cyst index, and whether the lesion was located in the TEAL. The results demonstrated that the TEAL was an independent risk factor for fractures [odds ratio (OR) =21.423, 95% confidence interval (CI): 2.409-190.539; P=0.006].
SBCs of humerus in children is often accompanied by pathological fracture. The lesion is located at TEAL, so we should be alert to the risk of pathological fracture.
单纯性骨囊肿（SBCs）是儿童常见的溶骨性病变，常导致患者非负重骨（肱骨）发生病理性骨折。囊肿指数是评估病理性骨折风险的经典指标，但由于囊肿在正位和侧位的面积偏差以及囊肿面积测定的主观性，该指标的可靠性降低。磁共振成像（MRI）能清晰显示囊肿边界，但预约周期长，儿童需在镇静状态下检查，临床医生无法及时判断。因此，临床需要寻找一种基础且简单的影像学评估指标。本研究旨在回顾性分析儿童肱骨单纯性骨囊肿病理性骨折的危险因素。
回顾性分析2014年1月至2021年12月期间SBCs患者的病历和X线平片。将患者分为骨折组（35例）和非骨折组（10例）。分析病理性骨折与儿童年龄、性别、囊肿指数之间的关系。还检查了胸大肌的存在情况以及病变与胸大肌和肱三头肌外侧头肌腱插入点（TEAL）的联系。进行二元逻辑回归分析。
对年龄、性别、囊肿指数以及病变是否位于TEAL进行二元逻辑回归分析。结果表明，TEAL是骨折的独立危险因素[比值比（OR）=21.423，95%置信区间（CI）：2.409 - 190.539；P = 0.006]。
儿童肱骨SBCs常伴有病理性骨折。病变位于TEAL，因此应警惕病理性骨折的风险。
