Ahmad Sohail, Alam Intekhab, Khan Abdul Qayyum, Abbas Mohammad Baqar, Chowdhry Madhav
Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, 202001, Uttar Pradesh, India.
J Orthop. 2023 Nov 3;46:143-149. doi: 10.1016/j.jor.2023.10.022. eCollection 2023 Dec.
Polidocanol sclerotherapy in the treatment of aneurysmal bone cysts (ABCs) with or without pathological fractures has been a topic of debate. While some studies recommend intralesional curettage as the preferred treatment, others suggest intralesional sclerosants as an effective alternative.
This study evaluates the use of polidocanol-based percutaneous sclerosant therapy in 28 patients with ABCs, of which 8 patients had pathological fracture. The patients received injections every four weeks based on clinical and radiological evaluation of the cyst, and the study assessed the results and complications of the treatment.
In group A (without pathological fractures), 14 out of 17 (82.4 %) lesions healed without any significant residual lesion. Three out of 17 (17.6 %) patients required further surgical intervention and were treated by curettage and bone grafting, definitively. Minor local inflammatory reaction was observed in 3 patients, which resolved without intervention within 3-4 days. In group B, all the 8 patients (100 %) with pathological fracture in their lesions healed as Grade 1 healing, without any significant residual lesion. One patient developed an episode of anesthesia related complication (delayed recovery) which resolved within an hour, without any residual effect. At final follow up, no recurrence was seen in any patient.
The study concludes that polidocanol sclerotherapy is an effective treatment option for patients with ABCs, with or without pathological fractures, and has the potential to become the new treatment of choice for pathological fractures due to its low invasiveness, low morbidity, and affordability. However, further research is needed to confirm the efficacy of polidocanol sclerotherapy in larger patient populations and to compare its effectiveness with other treatment options.
聚多卡醇硬化疗法用于治疗伴有或不伴有病理性骨折的骨囊肿一直是一个有争议的话题。虽然一些研究推荐病灶内刮除术作为首选治疗方法，但另一些研究则表明病灶内硬化剂是一种有效的替代方法。
本研究评估了基于聚多卡醇的经皮硬化剂疗法在28例骨囊肿患者中的应用，其中8例患者伴有病理性骨折。根据囊肿的临床和影像学评估，患者每四周接受一次注射，本研究评估了治疗结果和并发症。
在A组（无病理性骨折）中，17个病灶中有14个（82.4%）愈合，无明显残留病灶。17例患者中有3例（17.6%）需要进一步手术干预，最终接受了刮除术和骨移植治疗。3例患者观察到轻微的局部炎症反应，在3-4天内未经干预自行消退。在B组中，病灶伴有病理性骨折的8例患者全部（100%）达到1级愈合，无明显残留病灶。1例患者发生了与麻醉相关的并发症（恢复延迟），1小时内缓解，无任何残留影响。在最后随访时，所有患者均未见复发。
本研究得出结论，聚多卡醇硬化疗法对于伴有或不伴有病理性骨折的骨囊肿患者是一种有效的治疗选择，由于其低侵袭性、低发病率和可承受性，有可能成为病理性骨折的新的首选治疗方法。然而，需要进一步研究以证实聚多卡醇硬化疗法在更大患者群体中的疗效，并将其有效性与其他治疗选择进行比较。
