硬化治疗作为动脉瘤性骨囊肿的主要或挽救程序:单中心经验。

IF 2 Q2 ORTHOPEDICS World Journal of Orthopedics Pub Date : 2023-09-18 DOI:10.5312/wjo.v14.i9.698
Kolja Sebastian Weber, Claus Lindkær Jensen, Michael Mørk Petersen
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摘要

背景:动脉瘤性骨囊肿(ABC)是一种良性囊性骨肿瘤,具有溶骨性和局部侵袭性。作为首选的主要治疗方法(包括刮除和骨移植)的替代方案,已经描述了具有良好效果的替代治疗方法。在我们的科室,近年来,我们使用了波利多醇经皮硬化治疗。本研究的目的是确定波利多醇硬化治疗的治愈率和安全性。目的:确定波利多醇硬化治疗原发性和复发性ABC的有效性和安全性。11名患者(48%)曾接受过不同形式的既往治疗并复发。在全身麻醉和荧光镜引导下,重复经皮注射4毫克泊多醇/公斤体重。通过对电子医疗记录的审查,确定了以下内容:治愈率和复发率、治疗次数、性别、年龄、合并症、肿瘤位置和副作用/并发症,以及既往任何ABC手术。放射学随访的中位时间为19.5个月。结果:除一例(96%)外,所有ABC在中位注射4次(范围1-8)后均显示疾病愈合或稳定。在16例(70%)囊肿中观察到完全的临床和放射学愈合,而在6例(26%)中观察到部分放射学愈合并疼痛消退,被认为是稳定的疾病。未能愈合的囊肿此前曾接受过两次刮除术,但复发。一名患有大骨盆ABC的患者在注射两次后,血压突然下降,这种情况很快就会逆转。一名股骨颈近端ABC患者因畸形而出现轻微肢体长度差异。除此之外,没有观察到并发症。结论:聚多西诺经皮硬化治疗动脉瘤样骨囊肿是一种安全的替代方法。在我们的一系列原发性和复发性囊肿中,23例中有22例(96%)显示出治愈或稳定疾病的能力。需要进一步的研究来确定这是否能产生持久的效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Sclerotherapy as a primary or salvage procedure for aneurysmal bone cysts: A single-center experience.

Background: Aneurysmal bone cysts (ABC) are benign cystic bone tumors of an osteolytic and locally aggressive nature. As an alternative to the primary treatment of choice, which consists of curettage with bone grafting, alternative treatment methods with promising results have been described. At our department, we have, in recent years, used percutaneous sclerotherapy with polidocanol. The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol.

Aim: To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC.

Methods: Twenty-two consecutive patients (median age 12.5 years; range 1-27) with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively. Eleven patients (48%) had undergone different forms of previous treatment with recurrence. Under general anesthesia and fluoroscopic guidance, repeated percutaneous injections of 4mg polidocanol/kg body weight were performed. Through review of the electronic medical records, the following were identified: healing and recurrence rate, number of treatments, gender, age, comorbidity, location of the tumor and side effects / complications, as well as any previous surgery for ABC. The median length of radiographic follow-up was 19.5 mo.

Results: All ABCs except one (96%) showed healing or stable disease after a median of 4 (range 1-8) injections. Complete clinical and radiographic healing was observed in 16 cysts (70%), while partial radiographic healing with resolution of pain was seen in 6 cases (26%) and considered as stable disease. The cyst that failed to heal had previously undergone curettage twice with recurrence. One patient with a large pelvic ABC experienced, right after two injections, a sudden drop in blood pressure, which could quickly be reversed. One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity. Beyond that, no complications were observed.

Conclusion: Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts. In our series of both primary and recurrent cysts, it showed the ability to achieve healing or stable disease in 22 of 23 cases (96%). Further studies are needed to decide if this provides a long-lasting effect.

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