Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
Clinic for Orthopedics and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany.
Eur J Trauma Emerg Surg. 2023 Feb;49(1):361-372. doi: 10.1007/s00068-022-02077-9. Epub 2022 Aug 21.
Numerous approaches to the management of juvenile and aneurysmal bone cysts (ABC) are described in the specialist literature together with discussion of the associated healing and recurrence rates. Since there is currently no evidence-based treatment standard for these conditions, the aim of this systematic literature review with meta-analysis was to examine the different management approaches, evaluate the corresponding clinical outcomes and, as appropriate, to formulate a valid treatment recommendation.
A systematic search on OVID Medline based on a pre-existing search strategy returned 1333 publications. Having defined inclusion and exclusion criteria and analysis of the relevant full texts, 167 publications were included in the descriptive analysis and 163 in the meta-analysis. For this purpose, different subgroups were created, based on the type of cyst and the therapeutic procedure. Those subgroups were then analysed in relation to their healing rates, the number of recurrences and complication rates.
For aneurysmal bone cysts, both surgical removal and Doxycycline injection lead to excellent outcomes (98% healing) and low recurrence rates (6% and 11% resp.). Curettage (91% healing), including its combination with autologous cancellous bone graft (96% healing), showed very good healing rates but higher recurrence rates (22% and 15%, resp.), which were however improved by preoperative selective arterial embolization. A critical view must be taken of radiotherapy (90% healing) and the injection of alcohol (92% healing) because of their high complication rates (0.43/cyst and 0.42/cyst, resp.). In the management of juvenile bone cysts, surgical interventions like curettage and cancellous bone graft (87% healing) are far superior to non-surgical approaches (51% healing), furthermore, the application of autologous cancellous bone graft reduced the recurrence rate (3% recurrence) compared to curettage alone (20% recurrence). In subgroup analysis, treatment by ESIN was found to produce excellent outcomes (100% healing), though the patient collectives were small.
Surgical procedures to treat aneurysmal bone cysts appear to be the method of choice whereby Doxycycline injection may be an alternative. A surgical approach should be preferred in the treatment of juvenile bone cysts.
专业文献中描述了多种青少年和动脉瘤样骨囊肿（ABC）的治疗方法，并讨论了与之相关的愈合率和复发率。由于目前这些疾病没有基于证据的治疗标准，因此本系统文献回顾和荟萃分析的目的是检查不同的治疗方法，评估相应的临床结果，并在适当的情况下提出有效的治疗建议。
根据预先存在的搜索策略，在 OVID Medline 上进行系统搜索，共返回 1333 篇文献。在定义纳入和排除标准并分析相关全文后，167 篇文献被纳入描述性分析，163 篇文献被纳入荟萃分析。为此，根据囊肿类型和治疗程序创建了不同的亚组。然后根据愈合率、复发率和并发症率对这些亚组进行分析。
对于动脉瘤样骨囊肿，手术切除和强力霉素注射均能达到极好的效果（愈合率 98%），复发率低（分别为 6%和 11%）。刮除术（愈合率 91%），包括其与自体松质骨移植物的联合应用（愈合率 96%），显示出非常好的愈合率，但复发率较高（分别为 22%和 15%），但术前选择性动脉栓塞可改善复发率。由于高并发症率（分别为每囊肿 0.43 和 0.42），必须对放疗（愈合率 90%）和酒精注射（愈合率 92%）持批评态度。在青少年骨囊肿的治疗中，手术干预如刮除术和松质骨移植物（愈合率 87%）明显优于非手术方法（愈合率 51%），此外，与单独刮除术相比，应用自体松质骨移植物可降低复发率（复发率 3%）。在亚组分析中，发现 ESIN 治疗效果极好（愈合率 100%），但患者群体较小。
治疗动脉瘤样骨囊肿的手术方法似乎是首选方法，强力霉素注射可能是一种替代方法。在治疗青少年骨囊肿时，应首选手术方法。
