Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
Curr Opin Pediatr. 2023 Feb 1;35(1):131-137. doi: 10.1097/MOP.0000000000001205. Epub 2022 Nov 21.
Aneurysmal bone cysts are rare, locally aggressive bone tumors. Optimal treatment of ABCs is still matter of debate as therapies including sclerotherapy, selective arterial embolization and systemic treatment with denosumab are increasingly utilized, in addition to or instead of traditional curettage. The purpose of this review is to discuss current concepts and difficulties in diagnosing and treating primary ABCs, based on latest available literature.
In diagnostics, multiple new fusion partners of USP-6 have been described on next-generation sequencing specifically for primary ABCs. In a recent systematic review, failure rates of percutaneous injections and surgery were comparable. In a literature review, the use of denosumab seemed effective but resulted in multiple cases of severe hypercalcemia in children.
Accurately diagnosing primary ABC is crucial for treatment decisions. Curettage remains a valid treatment option, especially with adjuvant burring, autogenous bone grafting and phenolization. Percutaneous sclerotherapy represents a solid alternative to surgery, with polidocanol showing good results in larger studies. Systematic therapy with denosumab exhibits favorable results but should be reserved in the pediatric population for unresectable lesions, as it may result in severe hypercalcemia in children. When selecting a treatment option, localization, stability and safety should be considered.
动脉瘤样骨囊肿是一种罕见的局部侵袭性骨肿瘤。除传统的刮除术之外，或代替传统的刮除术，包括硬化治疗、选择性动脉栓塞和地舒单抗全身治疗等多种治疗方法的应用日益增多，因此 ABC 的最佳治疗方法仍存在争议。本文旨在根据最新文献讨论原发性 ABC 的诊断和治疗的最新概念和难点。
在诊断方面，在新一代测序中已经描述了多个新的 USP-6 融合伴侣，专门用于原发性 ABC。在最近的一项系统评价中，经皮注射和手术的失败率相当。在文献综述中，地舒单抗的应用似乎有效，但导致儿童发生多例严重高钙血症。
准确诊断原发性 ABC 对于治疗决策至关重要。刮除术仍然是一种有效的治疗选择，特别是辅助打磨、自体骨移植和苯酚化。经皮硬化治疗是一种替代手术的可靠方法，在较大的研究中聚多卡醇显示出良好的效果。地舒单抗的系统性治疗显示出良好的效果，但应保留在儿童不可切除病变中，因为它可能导致儿童严重高钙血症。在选择治疗方案时，应考虑定位、稳定性和安全性。
