Maurer F, Ambacher T, Weller S
Berufsgenossenschaftliche Unfallklinik, Tübingen.
Langenbecks Arch Chir. 1996;381(3):165-74. doi: 10.1007/BF00187622.
Various bone disorders become manifest as cystic lesions. The differential diagnosis must include benign and malignant tumors and also non-tumorous lesions, such as osteomyelitis. The most important and most frequent types of genuine bone cyst are juvenile bone cyst and aneurysmal bone cyst. When juvenile bone cysts occur in adults they are called solitary bone cysts. Despite intensive research the pathogenesis of bone cysts is still unknown to this day, so that successful causal therapy is impossible. The main problem in the treatment of bone cysts is their high rate of recurrence, rates ranging between 20% and 50% having been cited in the international literature. A critical review of the literature reveals few publications with helpful follow-up results. Most of the publications are case reports, and they frequently merely describe various forms of treatment. More recent reports are mainly concerned with such methods as curettage, steroid injections, and continuous decompression with perforated screws. Until the early 1980s, segmental bone resection was the treatment of choice. Because of its high complication rate it has since been abandoned. In the last analysis, the only well-established method for which long-term results obtained in studies of any size have been published, is curettage of the cyst and grafting with cancellous bone from the iliac crest. In our series, 41 patients were treated with this method, and we recorded a recurrence rate of 17.1%. Complications were rare. The risk of recurrence depended on the age of the patient. A higher recurrence rate must be expected in children under the age of 10 years. For this reason, operative treatment should not be performed until after that age if possible. Newer methods, such as steorid injections and continuous decompression by means of perforated screws, had better results in some studies, but only according to a few authors. Further research is needed to show whether our method will yield good results in the long term when applied in larger patient collectives.
各种骨疾病表现为囊性病变。鉴别诊断必须包括良性和恶性肿瘤，以及非肿瘤性病变，如骨髓炎。真正的骨囊肿最重要且最常见的类型是青少年骨囊肿和动脉瘤样骨囊肿。青少年骨囊肿发生于成年人时被称为孤立性骨囊肿。尽管进行了深入研究，但骨囊肿的发病机制至今仍不清楚，因此无法进行成功的病因治疗。骨囊肿治疗的主要问题是其高复发率，国际文献报道的复发率在20%至50%之间。对文献的批判性回顾发现，很少有出版物给出有用的随访结果。大多数出版物是病例报告，它们常常只是描述了各种治疗方式。最近的报告主要涉及刮除术、类固醇注射以及用多孔螺钉持续减压等方法。直到20世纪80年代初，节段性骨切除术一直是首选治疗方法。由于其高并发症发生率，此后已被摒弃。归根结底，唯一有任何规模研究发表了长期结果的成熟方法是刮除囊肿并用取自髂嵴的松质骨进行植骨。在我们的系列研究中，41例患者采用了这种方法治疗，我们记录的复发率为17.1%。并发症很少见。复发风险取决于患者年龄。10岁以下儿童的复发率预计会更高。因此，如果可能的话，手术治疗不应在该年龄之前进行。一些研究表明，类固醇注射和用多孔螺钉持续减压等较新的方法取得了较好的效果，但只有少数作者这样认为。需要进一步研究以表明我们的方法应用于更大规模的患者群体时从长期来看是否会产生良好效果。
