动脉瘤样骨囊肿的治疗

[目的]探讨动脉瘤样骨囊肿的治疗方法及其与复发的关系。[方法]对本院1990～2003年手术的动脉瘤样骨囊肿16例手术患者进行回顾性分析，16例中15例行病灶刮除，刮除后自体骨填充3例，异体骨填充5例，自体骨加异体骨填充5例，自体骨加入工骨2例；其中术中磨钻使用4例。[结果]术后随访2～5年，15例行刮除术中复发2例，复发率13．3％。复发部位分别发生于股骨远端及肱骨近端。其中术中使用磨钻的4例未见复发；大块切除1例亦未见复发。[结论]动脉瘤样骨囊肿刮除彻底与否是预防术后复发的关键，术中应用磨钻可降低复发率。     

动脉瘤样骨囊肿15例诊治体会

对15例动脉瘤样骨囊肿采用刮除植骨或病灶刮除后骨水泥充填等方面进行处理,并对其临床表现,X线照片,血管造影等进行回顾性分析。15例中仅1例术中前确诊,囊肿刮除植骨9例,骨水泥充填6例,均疗效满意,动脉瘤样骨囊肿是一种少见的良性骨肿瘤样病变,极易误诊,活检是明确诊断的重要手段,刮除植骨效果良好,对年龄较大可采用骨水泥充填。     

跟骨骨囊肿刮除后自体髂骨结合羟基磷灰石人工骨植骨治疗的疗效分析

目的通过回顾性分析,评价跟骨骨囊肿刮除后自体髂骨结合羟基磷灰石人工骨植骨治疗跟骨骨囊肿的疗效。方法骨囊肿刮除后以自体髂骨结合羟基磷灰石人工骨植骨（1：3）治疗9例跟骨骨囊肿,采用临床指标和放射学指标进行疗效评估。结果本组随访0．5—2年,平均1．2年。9例术后2周内均有不同程度切口疼痛,经治疗后好转。术后6个月除1例轻微疼痛外,其余疼痛消失。临床治愈时间3～5个月,平均3．3个月。结论自体髂骨及羟基磷灰石人工骨在骨囊肿刮除术后骨质缺损区可通过爬行替代作用成骨,此方法治疗跟骨骨囊肿疗效较好。     

跟骨肿瘤与瘤样病变17例

目的足踝部肿瘤尤其是跟骨肿瘤非常少见,多数临床医师对跟骨肿瘤认识较少,延误诊断和治疗不当很常见。总结并回顾我院治疗的跟骨肿瘤病例及相关文献,评价其诊断及治疗方法。方法自2003年1月至2007年12月共收治17例跟骨原发肿瘤,其中男性13例,女性4例;年龄13～67岁,平均年龄31.5岁。均行病灶刮除植骨术。结果术后病理证实,跟骨脂肪瘤7例（8足）,软骨母细胞瘤6例（6足,其中5例继发动脉瘤样骨囊肿）,单纯性骨囊肿2例（2足）,骨内腱鞘囊肿2例（2足）。17例均获随访,随访时间29～76个月,平均52个月。术后均无复发病例。结论跟骨肿瘤少见,多为良性,原发或转移性恶性肿瘤罕见。诊断依赖于临床表现、影像学检查和病理检查,多数肿瘤通过临床表现、影像学检查可以明确性质。对良性肿瘤可以随访观察,常规手术方案为经外侧入路行病灶刮除植骨。恶性肿瘤多采取膝下截肢。     

股骨近端骨囊肿并病理性骨折的治疗

[目的]探讨股骨近端骨囊肿并病理性骨折的有效治疗方法。[方法]采用切开复位骨折内固定病灶刮除植骨治疗股骨近端骨囊肿并病理性骨折46例。[结果]随访1～5年,平均2.6年。术后复查X线片示:45例患者骨愈合时间6～18个月,平均13个月,骨折愈合无复发。1例骨折愈合后21个月复发,二期病灶刮除植骨,术后随访4年愈合良好未复发。[结论]应用切开复位骨折内固定病灶刮除植骨治疗股骨近端骨囊肿并病理性骨折效果满意,并发症少。     

通过注射脱钙骨和自体骨髓治疗动脉瘤样骨囊肿

背景：在假设动脉瘤样骨囊肿通过内部骨化存在自愈潜能的基础上，发展出一种新的、微创的治疗动脉瘤样骨囊肿方法。即用脱矿物质骨粉混合自体骨髓注入骨囊肿内，从而使病变停止进展，并自行骨化。我们提出假设，即为了诱导骨质愈合。骨囊肿细胞只需要对诱导材料的作用产生反应，而囊肿刮除术或扩大的外科手术是不必要的。此项研究的目的在于评估这种新方法对于骨囊肿的治愈情况，及其治疗本病的复发率的因素。方法：对13例经活检确诊为动脉瘤样骨囊肿的患者，经小切口向病灶内注入脱矿物质骨和自体骨髓混合骨泥。研究组中男3例，女10例，平均年龄16．6岁。病灶部位位于长骨者6例，骨盆5例，位于肩关节盂和跟骨者各1例。其中5例患者既往未经任何治疗，1例经术前栓塞，其余7例患者为治疗后复发者。结果：经过平均3．9年的随访，其中11例患者获得治愈。结论：该微创方法能够促进原发性动脉瘤样骨囊肿自愈。采用该治疗方法不再需要进行刮除术。能够避免过大的外科手术及失血，并且对于位于类似骨盆这样不容易暴露部位的病灶，可以使操作更为便捷。     

空心钉持续减压治疗单纯骨囊肿初步报告

骨囊肿是一种常见于儿童和青少年骨干骺端的囊性病变，占骨种瘤样病变的22.68%，骨囊肿的治疗方法很多，包括手术刮除植骨或骨膜植入，克氏针穿策引流，     

原发动脉瘤样骨囊肿117例临床回顾分析

背景：刮除植骨是原发动脉瘤样骨囊肿的主要治疗方式,其他治疗方式如切除、激素注射、栓塞也见诸报道,均可获得较为满意的治愈率。目的：回顾性分析117例原发动脉瘤样骨囊肿的流行病学特点及影响其复发的相关因素,探讨原发动脉瘤样骨囊肿的治疗方案。方法：1993年2月至2011年5月共收治原发动脉瘤样骨囊肿117例,男68例,女49例;年龄7～60岁,平均23.1岁,中位年龄21岁;病变主要位于股骨、胫骨、脊柱、骨盆及肱骨。治疗手段主要为病灶刮除,还包括局部切除、激素注射、栓塞、放疗、单纯内固定。结果：1年以上随访期77例,随访时间为12～176个月,平均36个月。7例复发,术后复发时间为6～102个月,中位术后复发时间为20个月,复发率为9.1%。复发病例均为病灶刮除患者,其中骨盆3例,股骨4例。初始行非手术治疗8例,其中6例可见病变修复。结论：病灶刮除仍是原发动脉瘤样骨囊肿的主要治疗手段,骨盆病变及复发病变接受治疗后的复发风险较大,对病变部位手术难度大或术后肢体功能影响较大的病变可试行非手术治疗,合理的治疗方案选择有助于控制复发率并保留肢体功能。     

Osteoset人工骨在骨囊肿治疗中的应用

目的观察Osteoset人工骨颗粒治疗骨囊肿的临床疗效。方法 15例骨囊肿患者均采用病灶刮除＋Os-teoset人工骨颗粒植骨治疗。男9例,女6例,年龄3-35岁,平均17.5岁。骨囊肿平均4 cm×2.3 cm×1.5 cm大小,术中植入Osteoset人工骨颗粒5-40 g。结果 15例患者均获随访,随访15年,平均18个月,无患肢疼痛及功能障碍,无一例复发。结论病灶刮除＋Osteoset人工骨颗粒植骨是治疗骨囊肿的一种较好的方法。     

手术治疗18例儿童干骺端骨囊肿

目的探讨病灶刮除、同种异体骨植骨、锁定钛板内固定术治疗儿童干骺端骨囊肿的临床疗效。方法对18例干骺端骨囊肿患儿均采用病灶刮除、无水乙醇囊肿壁组织灭活、同种异体骨植骨、锁定板内固定治疗。结果 18例患儿均获得随访,时间11～34个月。患儿均无患肢疼痛及功能障碍,无复发。结论切开病灶刮除、同种异体骨植骨、锁定钛板内固定治疗儿童干骺端骨囊肿疗效较好。     

Patellar pathologic fracture secondary to aneurysmal bone cyst. A case report

Aneurysmal bone cyst is a tumor-like lesion which accounts for about 1% of all biopsied tumors and tumor-like lesions of bone. We report an extremely rare case of aneurysmal bone cyst of the patella in an 18-year-old patient revealed by a pathological fracture. The unexpected appearance of a pathological fracture affects the whole therapeutical management. However, in the case of a well-preserved articular surface, curettage and corticocancellous grafting are considered to be successful methods of treatment for aneurysmal bone cyst of the patella, as revealed in our study.     

Secondary aneurysmal bone cyst of the patella

Aneurysmal bone cyst accounts for 1% of primary bone tumors and is one of the benign tumor-like lesions. Patellar involvement is quite rare. Its development on the basis of any previous lesion such as chondroblastoma is called secondary aneurysmal bone cyst. A 26-year-old male patient presented with right knee pain of three-year history. Physical examination showed a firm, immobile swelling at the anterior aspect of the right knee, without increase in temperature or redness of the skin. There was no pain on palpation and joint range of motion was normal. Radiological studies were suggestive of an aneurysmal bone cyst. At surgery, the cystic lesion was removed via curettage and the residual cavity was filled with an autogenous bone graft taken from the iliac wing. The histopathologic diagnosis was secondary aneurysmal bone cyst in association with chondroblastoma. During a 1.5-year follow-up, the patient had no complaint and no recurrence was observed.     

An atypical aneurysmal bone cyst of the head of the humerus, arthroscopic treatment: a case report

Curettage and bone grafting are the accepted methods of treatment of aneurysmal bone cysts. Unfortunately, recurrence is common. We treated a patient with atypical aneurysmal bone cyst of the head of the humerus that lacked aneurysmal dilatation by arthroscopic curettage without bone grafting. New bone formation and remodeling was observed in this patient. There was no evidence of recurrence. Arthroscopic curettage without bone grafting is a simple and effective treatment for aneurysmal bone cyst.     

Aneurysmal bone cyst of the vertebra with paraplegia

Aneurysmal bone cyst, a benign lesion, is difficult to diagnose radiologically, particularly in the spine, but has a characteristic microscopic appearance. Treatment of spinal lesions consists of curettage, with or without bone grafting, together with irradiation at low doses (1000 to 2000 rads). The author reports a case of aneurysmal bone cyst of the neural arch associated with neurologic complication, which illustrates some typical features of such cysts of the spine. The condition should always be considered in patients with lytic lesions of the spine, and prompt surgical intervention is recommended.     

Primary aneurysmal bone cyst of the patella: a case report

Aneurysmal bone cysts account for less than 1% of primary bone tumours and have a predilection for the metaphyses of the long bones of the leg. Only 1% of all aneurysmal bone cysts occur in the patella. We report on a 30-year-old man with a primary aneurysmal bone cyst in the right patella treated with curettage. The defect was filled with demineralised bone matrix and allogeneic cancellous bone graft. At the 1.5-year follow-up, the bone graft was well incorporated, the patient experienced no pain or tenderness and had a full range of knee movement.     

Aneurysmal bone cyst of the hand: a report of four cases.

Aneurysmal bone cysts are benign lesions that rarely occur in the bones of the hand. Curettage and bone grafting are the most common treatment modalities performed considering the possible functional loss after total excision. Four cases of aneurysmal bone cyst of the hand were identified. Three out of four cases were treated initially with curettage and bone grafting alone without any other local therapy. One had total excision of the lesion. There were two recurrences in the curettage group. Both were treated with excision and followed up for a minimum of 12 months. Curettage alone was associated with high recurrence rates. Total excision of the lesion was the most successful procedure employed. In view of the high recurrence rates following curettage alone and non-neoplastic nature of the lesion, adjuvant treatment modalities such as cryosurgery, electric cauterisation should be considered for initial treatment of ABC. Resection should be preserved for recurrent cases.     

Unusual localization of an aneurysmal bone cyst in ulnar coronoid process

Aneurysmal bone cysts are non-neoplastic, expansile, osteolytic tumor-like conditions. All bones may be involved, but the most commonly affected is the metaphysis of the long bones, especially the tibia, humerus and femur. We present a 13-year-old female patient with a cystic lesion with cortical continuity and a large bone cyst in the coronoid process of the ulna. The bone cyst was treated with curettage, phenol application and cement implantation following cyst debulking. Aneurysmal bone tumors are rare tumor-like conditions and localization at the coronoid process of the ulna with mechanical block of the elbow motion has yet to be reported. Debulking and curettage of the lesion and bone cement implantation are useful methods for local control of aneurysmal bone cysts.     

Severe life-threatening hypersensitivity reaction to polidocanol in a case of recurrent aneurysmal bone cyst

Aneurysmal bone cysts (ABC) are expansile lytic lesions constituting around 1% of all benign bone tumors with an annual incidence of 1.4/100000. A variety of treatments are available ranging from curettage with or without bone grafting (autologous or allogeneic), curettage with use of adjuvants [Polymethylmethacrylate (PMMA) bone cement, high speed burr, phenol, liquid nitrogen], wide en-block excision with or without reconstruction, selective arterial embolization of the feeding vessels, radiation therapy, high precision megavoltage radiotherapy and percutaneous radio-nuclide ablation, sclerotherapy (ethibloc, aetoxisclerol, alcohol gel, polidocanol). The optimal treatment is debatable due to various indications and contraindications of different modalities of treatment. Recent data suggest that percutaneous sclerotherapy with polidocanol is safe and effective alternative to surgery for treatment of ABCs as it has minimal side effects. We are reporting the first case of life-threatening adverse reaction to intra-lesional polidocanol in a three-year-old boy with a proximal femoral aneurysmal bone cyst. The importance of reporting this case is to make people aware regarding the adverse reaction of polidocanol and to highlight the precautions one should follow while using polidocanol for aneurysmal bone cysts.     

Current treatments of primary aneurysmal bone cysts

The management of aneurysmal bone cyst depends on the age of the patient, the location, extent, aggressiveness and the size of the lesion. In the light of their experience and a review of the literature of 1256 aneurysmal bone cysts, the authors analyzed various treatment modalities. Inactive lesions can heal with biopsy or curettage alone. In active or aggressive lesions, elective treatment usually consists of curettage, whether associated or not with bone grafting and local adjuvants. Aneurysmal bone cyst in young children do not seem more aggressive than in older children. In pelvic locations, the emergence of a few cases of spontaneous healing (even in active or aggressive lesions) encourages the adoption of clinical and radiological supervision for some months after biopsy when possible. In some cases, the localization and extent of the cyst are such that operative treatment is extremely hazardous. Selective arterial embolization has made a considerable contribution towards the therapeutic solution of such cases. For some authors, direct percutaneous Ethibloc injection can be recommended as the first-choice treatment except in spinal lesions. Nevertheless, the complications encountered in some series after percutaneous embolization of aneurysmal bone cyst with Ethibloc should encourage the use of Ethibloc injection not as an initial treatment but as a reliable alternative to surgery.     

Alternative surgical treatment for giant-cell reparative granuloma in the metacarpal, using phenol and ethanol adjuvant therapy

Giant-cell reparative granuloma (GCRG) or a solid variant of an aneurysmal bone cyst (ABC) is an uncommon benign reactive lesion with a predilection for the small tubular bones of the hands and feet. Treatment usually involves wide resection or amputation because of unacceptable high recurrence rates after curettage. Adjuvant therapy usually is applied to reduce the recurrence of locally aggressive bone tumors. We report 2 cases of GCRG that were treated successfully with curettage, adjuvant phenol and ethanol, and autogenous bone grafting.