Jamshidi Khodamorad, Toloue Ghamari Babak, Shams Roshanak, Bagherifard Abolfazl
Department of Orthopedics, School of Medicine, Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran.
Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Shoulder Elbow Surg. 2025 Aug;34(8):e664-e671. doi: 10.1016/j.jse.2024.11.006. Epub 2024 Dec 30.
Many unicameral bone cysts (UBCs) can be resolved or treated conservatively. Managing persistent symptomatic UBCs in the humerus is particularly challenging. An effective surgical method with low complications is significant for treatment. This study evaluated the effectiveness of inserting a fibular strut allograft retrogradely into the humerus UBC, focusing on cyst healing, concurrent pathologic fracture union, and complications.
We conducted a retrospective analysis of medical records from 2001 to 2020 to review cases of UBCs who underwent surgery at our referral hospital. In cases where cysts persisted despite 3 steroid injections and were symptomatic or presented with a pathologic fracture, surgical intervention was considered. Of the initial 43 patients, 15 met the inclusion criteria for this study, and they were treated with retrograde insertion of a fibular strut allograft into the medullary canal, comprising 10 males and 5 females. A cyst filled with bone within 24 months is considered healed in radiographic appearance. When areas of radiolucency remain, it is called residual. Fracture union was identified by observing the bridging of at least 3 of the 4 cortical views by bone performed 3 months after surgery. The Musculoskeletal Tumor Society scoring system was used to evaluate patients' functional outcomes.
After a mean of 54.7 months of follow-up, 13 patients demonstrated complete cyst healing. None of the patients exhibited delayed healing. Two patients displayed cyst healing with residual, which remained stable throughout the last follow-up. All fracture cases achieved union within 3 months postoperation. The patients exhibited favorable functional outcomes, with a mean Musculoskeletal Tumor Society score of 29.6 (28-30).
Retrograde fibular strut allograft insertion into the medullary canal effectively manages symptomatic UBCs in the humeral bone, especially those in or extending to the middle or distal regions. A comparative study is recommended for further validation.
许多单房性骨囊肿（UBC）可以自行消退或采用保守治疗。处理肱骨中持续存在的有症状的UBC尤其具有挑战性。一种并发症少的有效手术方法对于治疗至关重要。本研究评估了逆行插入腓骨支撑异体骨治疗肱骨UBC的有效性，重点关注囊肿愈合、并发病理性骨折愈合及并发症情况。
我们对2001年至2020年的病历进行了回顾性分析，以回顾在我们转诊医院接受手术的UBC病例。对于经3次类固醇注射后囊肿仍持续存在且有症状或出现病理性骨折的病例，考虑进行手术干预。最初的43例患者中，15例符合本研究的纳入标准，他们接受了腓骨支撑异体骨逆行插入髓腔的治疗，其中男性10例，女性5例。术后24个月内囊肿内充满骨在影像学上视为愈合。若仍有透亮区，则称为残留。术后3个月通过观察4个皮质层面中至少3个层面有骨桥接来确定骨折愈合情况。采用肌肉骨骼肿瘤学会评分系统评估患者的功能结局。
平均随访54.7个月后，13例患者囊肿完全愈合。所有患者均未出现延迟愈合。2例患者囊肿愈合但有残留，在最后一次随访时保持稳定。所有骨折病例均在术后3个月内实现愈合。患者功能结局良好，肌肉骨骼肿瘤学会平均评分为29.6（28 - 30）。
腓骨支撑异体骨逆行插入髓腔可有效治疗肱骨中有症状的UBC，尤其是位于或延伸至中、远端区域的UBC。建议进行比较研究以进一步验证。
