The Journal of the Korean bone and joint tumor society (대한골관절종양학회지)

The Korean Musculoskeletal Tumor Society (대한근골격종양학회)
권호 표지
DOI QR코드

DOI QR Code

Conservative Management in Simple Bone Cyst

단순 골 낭종의 보존적 치료

  • Kim, Ji-Youn (Department of Orthopaedic Surgery, Yonsei University College of Medicine) ;
  • Cho, Yong-Jin (Department of Orthopaedic Surgery, Yonsei University College of Medicine) ;
  • Shin, Kyoo-Ho (Department of Orthopaedic Surgery, Yonsei University College of Medicine)
  • 김지연 (연세대학교 의과대학 정형외과학교실) ;
  • 조용진 (연세대학교 의과대학 정형외과학교실) ;
  • 신규호 (연세대학교 의과대학 정형외과학교실)
  • Received : 2011.10.28
  • Accepted : 2011.12.02
  • Published : 2011.12.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study evaluated the results of conservative treatment for simple bone cyst. Materials and Methods: We studied 126 cases of simple bone cyst, which were treated by observation or steroid injection from February 1990 to May 2010. Their mean age at diagnosis was 14 years (${\pm}9$ years, 2-60 years) and the mean follow-up duration for this study were 41 months (${\pm}37$ months, 12-159 months). Observation and steroid injection was applied for conservative management of simple bone cyst and results was scored by modified Neer classification. Results: 31 cases (24.6%) were treated by observation and 95 cases (75.4%) were treated by steroid injection. The 95 patients were treated by a mean of 1.1 (${\pm}0.9$, 0-4) steroid injections and a single steroid injection was given in 65 cases (51.6%). The 102 cases (80.9%) were resulted in modified Neer classification I and II which could be considered as healing of simple bone cyst. Conclusion: Conservative management can be considered as an initial treatment for simple bone cyst with good result.

목적: 단순 골 낭종에 대해 관찰 요법 또는 국소적 스테로이드 주입술을 통한 보존적 치료를 시행한 결과에 대하여 보고하고자 한다. 대상 및 방법: 1990년 2월부터 2010년 5월까지 단순 골 낭종으로 진단된 153명 중 보존적 치료만을 시행한 126명을 대상으로 하였다. 진단시 평균 연령은 14세(${\pm}9$세, 2-60세)였으며 평균 추시 관찰 기간은 41개월(${\pm}37$개월, 12-159개월)이었다. 보존적 치료의 치료 결과에 대해 변형 Neer 분류로 나누어 비교하였다. 결과: 단순 골 낭종으로 진단되어 보존적 치료를 실시한 환자 중 관찰 요법만 실시한 경우는 31예(24.6%)였고, 스테로이드 주입술을 실시한 경우는 95예(75.4%)였다. 보존적 치료 후의 결과는 변형 Neer 분류상 치유에 해당하는 Grade I, II가 102예(80.9%)였다. 결론: 단순 골 낭종의 일차적 치료로 보존적 치료를 고려하여야 한다.

Keywords

References

  1. Di Bella C, Dozza B, Frisoni T, Cevolani L, Donati D. Injection of demineralized bone matrix with bone marrow concentrate improves healing in unicameral bone cyst. Clin Orthop Relat Res. 2010;468:3047-55. https://doi.org/10.1007/s11999-010-1430-5
  2. Cohen J. Etiology of simple bone cyst. J Bone Joint Surg Am. 1970;52:1493-7. https://doi.org/10.2106/00004623-197052070-00030
  3. Cohen J. Unicameral bone cysts. a current synthesis of reported cases. Orthop Clin North Am. 1977;8:715-36.
  4. Fahey JJ, O'Brien ET. Subtotal resection and grafting in selected cases of solitary unicameral bone cyst. J Bone Joint Surg Am. 1973;55:59-68. https://doi.org/10.2106/00004623-197355010-00004
  5. Spence KF Jr, Bright RW, Fitzgerald SP, Sell KW. Solitary unicameral bone cyst: treatment with freeze-dried crushed cortical-bone allograft. A review of one hundred and fortyfour cases. J Bone Joint Surg Am. 1976;58:636-41. https://doi.org/10.2106/00004623-197658050-00010
  6. Neer CS 2nd, Francis KC, Marcove RC, Terz J, Carbonara PN. Treatment of unicameral bone cyst. A follow-up study of one hundred seventy-five cases. J Bone Joint Surg Am. 1966;48:731-45. https://doi.org/10.2106/00004623-196648040-00006
  7. Capanna R, Dal Monte A, Gitelis S, Campanacci M. The natural history of unicameral bone cyst after steroid injection. Clin Orthop Relat Res. 1982;166:204-11.
  8. Delloye C, Docquier PL, Cornu O, et al. Simple bone cysts treated with aspiration and a single bone marrow injection. A preliminary report. Int Orthop. 1998;22:134-8. https://doi.org/10.1007/s002640050225
  9. Lokiec F, Ezra E, Khermosh O, Wientroub S. Simple bone cysts treated by percutaneous autologous marrow grafting. A preliminary report. J Bone Joint Surg Br. 1996;78:934-7. https://doi.org/10.1302/0301-620X78B6.6840
  10. Rougraff BT, Kling TJ. Treatment of active unicameral bone cysts with percutaneous injection of demineralized bone matrix and autogenous bone marrow. J Bone Joint Surg Am. 2002;84A:921-9.
  11. Shinozaki T, Arita S, Watanabe H, Chigira M. Simple bone cysts treated by multiple drill-holes. 23 cysts followed 2-10 years. Acta Orthop Scand. 1996;67:288-90. https://doi.org/10.3109/17453679608994691
  12. Wilkins RM. Unicameral bone cysts. J Am Acad Orthop Surg. 2000;8:217-24. https://doi.org/10.5435/00124635-200007000-00002
  13. Oppenheim WL, Galleno H. Operative treatment versus steroid injection in the management of unicameral bone cysts. J Pediatr Orthop. 1984;4:1-7. https://doi.org/10.1097/01241398-198401000-00001
  14. Scaglietti O, Marchetti PG, Bartolozzi P. The effects of methylprednisolone acetate in the treatment of bone cysts. Results of three years follow-up. J Bone Joint Surg Br. 1979;61B:200-4.
  15. Wright JG, Yandow S, Donaldson S, Marley L. Simple Bone Cyst Trial Group. A randomized clinical trial comparing intralesional bone marrow and steroid injections for simple bone cysts. J Bone Joint Surg Am. 2008;90:722-30. https://doi.org/10.2106/JBJS.G.00620
  16. Hashemi-Nejad A, Cole WG. Incomplete healing of simple bone cysts after steroid injections. J Bone Joint Surg Br. 1997;79:727-30. https://doi.org/10.1302/0301-620X.79B5.7825
  17. Sung AD, Anderson ME, Zurakowski D, Hornicek FJ, Gebhardt MC. Unicameral bone cyst: a retrospective study of three surgical treatments. Clin Orthop Relat Res. 2008;466:2519-26. https://doi.org/10.1007/s11999-008-0407-0
  18. Neer CS, Francis KC, Johnston AD, Kiernan HA Jr. Current concepts on the treatment of solitary unicameral bone cyst. Clin Orthop Relat Res. 1973;97:40-51. https://doi.org/10.1097/00003086-197311000-00008
  19. Sakamoto A, Matsuda S, Yoshida T, Iwamoto Y. Clinical outcome following surgical intervention for a solitary bone cyst: emphasis on treatment by curettage and steroid injection. J Orthop Sci. 2010;15:553-9. https://doi.org/10.1007/s00776-010-1485-x
  20. Makley JT, Joyce MJ. Unicameral bone cyst (simple bone cyst). Orthop Clin North Am. 1989;20:407-15.
  21. Canavese F, Wright JG, Cole WG, Hopyan S. Unicameral bone cysts: comparison of percutaneous curettage, steroid, and autologous bone marrow injections. J Pediatr Orthop. 2011;31:50-5. https://doi.org/10.1097/BPO.0b013e3181ff7510
  22. Farber JM, Stanton RP. Treatment options in unicameral bone cysts. Orthopedics. 1990;13:25-32.
  23. Catier P, Bracq H, Canciani JP, Allouis M, Babut JM. The treatment of upper femoral unicameral bone cysts in children by Ender's nailing technique. Rev Chir Orthop Reparatrice Appar Mot. 1981;67:147-9.
  24. Jaffe KA, Dunham WK. Treatment of benign lesions of the femoral head and neck. Clin Orthop Relat Res. 1990;257:134-7.
  25. Garceau GJ, Gregory CF. Solitary unicameral bone cyst. J Bone Joint Surg Am. 1954;36:267-80. https://doi.org/10.2106/00004623-195436020-00005
  26. Roposch A, Saraph V, Linhart WE. Treatment of femoral neck and trochanteric simple bone cysts. Arch Orthop Trauma Surg. 2004;124:437-42.
  27. Campanacci M, Capanna R, Picci P. Unicameral and aneurysmal bone cysts. Clin Orthop Relat Res. 1986;204:25-36.