Less invasive stabilization system plate fixation combined with bone cement for the treatment of distal femoral aneurysmal bone cyst

doi:10.3969/j.issn.2095-4344.2013.39.023

Abstract

Abstract:

BACKGROUND: The previous literatures have reported that the aneurysmal bone cyst has a high recurrence rate after curettage treatment.
OBJECTIVE: To investigate the effect of less invasive stabilization system plate fixation combined with bone cement in the treatment of distal femoral aneurysmal bone cyst.
METHODS: A retrospective analysis was conducted in 19 patients with distal femoral aneurysmal bone cyst who treated with less invasive stabilization system plate fixation combined with bone cement in the First Hospital of Qinhuangdao between January 2002 and January 2012. The purpose of the treatment of aneurysmal bone cyst was to completely remove the cyst and prevent recurrence, and to repair and reconstruct the structure and function of the damaged tissues through implant fixation.
RESUTLS AND CONCLUSION: The 19 patients were followed-up for 1-3 years after treated with less invasive stabilization system plate fixation combined with bone cement, and 18 cases recovered well, one case had recurrence at 2 years after treatment. Complete removal of aneurysmal bone cyst is the key for the prevention of recurrence. The less invasive stabilization system plate is the combination of advantages of intramedullary nail and the biological locking plate technology, which has many advantages in the treatment of aneurysmal bone cyst. Filling the lesion area with bone cement had certain killing effect on tumor, and can increase the bone strength in the lesion area. The surgical treatment of distal femoral aneurysmal bone cyst is to clear the cystic lesions firstly, and then to prevent the recurrence through less invasive stabilization system plate fixation combined with bone cement.

Key words: prostheses and implants, bone cysts, aneurysmal, curettage

CLC Number:

R318

Li Xue-jin, Wen Xiao-yan, Xu Jie, Wang Wei, Li Qun, Pei Bao-yan. Less invasive stabilization system plate fixation combined with bone cement for the treatment of distal femoral aneurysmal bone cyst[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(39): 7009-7014.

Figures/Tables 1

2.1 腰椎动脉瘤样骨囊肿植入物内固定治疗张晓林等[5]报道12例腰椎动脉瘤样骨囊肿患者的外科治疗，选择性动脉栓塞以减少囊肿内的血液灌流，3例腰椎动脉瘤样骨囊肿患者行后段结构切除加后路椎弓根系统内固定，对4例患者行前段结构切除加钛网及侧方钛板内固定，5例行一期联合前后路治疗。治疗后24-48 h伤口放置负压引流，2周后在支具的保护下可以下床活动。疗效判定标准：优，恢复工作无腰背痛，无神经受累症状，X射线片显示植骨块为骨性融合；差：脊柱失稳，慢性腰背痛，神经损害无改善，X射线片显示植骨块不融合；良：各标指标介于优与差之间。治疗后1年X射线片复查，观察治疗效果及复发。对患者进行2-4年随访，平均随访3.1年。治疗后12例患者中，优7例，良5例。可见，动脉瘤样骨囊肿病灶可以通过治疗前选择性动脉栓塞、经前路彻底切除以及随后经后路行腰椎固定融合联合治疗。对于脊柱动脉瘤样骨囊肿的患者，应该首选外科治疗的方法，并争取对原发灶彻底切除，以防止肿瘤在局部复发。王凯[6]也进行同样研究，选取8例腰椎动脉瘤样骨囊肿进行植入物内固定治疗，治疗前先对病损部位进行准确定位，选择性动脉栓塞，2例患者行后段结构切除加后路椎弓根系统内固定，2例患者经前中行前段结构切除加钛网及侧方钛板内固定，4例同时涉及前后段的患者行一期联合前后路治疗，治疗后随访2-4年，疗效判定为优7例，良1例。对于腰椎动脉瘤样骨囊肿病灶涉及横突或棘突，可完整切除局部病灶，当椎体受累及时，前后路联合治疗并辅以脊柱内固定系统是必要的[7]。大范围肿瘤的切除会导致脊柱失去稳定性，通常需要植骨融合来维持脊柱稳定性[8]。大范围病灶切除后应用脊柱内固定技术，可以保持脊柱的高度及稳定性。涉及后段结构的患者，经后路行后段结构切除加后路椎弓根系统内固定；涉及前段结构的患者，经前路行前段结构切除加钛网及侧方钛板内固定；涉及前后段患者，则行一期联合前后路治疗加钛网以及侧方钛板内固定加后路椎弓根系统内固定。 2.2 动脉瘤样骨囊肿的外固定支架结合同种异体骨植骨治疗刘永裕等[9]报道8例长骨干动脉瘤样骨囊肿的治疗，将病变部位骨皮质凿穿开窗，清除囊内液体，行病灶局部刮除，腔内给予体积分数95%乙醇灭活15 min，在病灶近远侧用1支4.0 mm克氏针打2个孔，相隔4-10 cm，用半螺纹钉拧入，止于对侧皮质外，上单边外固定支架，病灶切刮后骨缺损填充采用同种异体脱钙松质骨条，使原囊肿区无空隙，逐层闭合伤口。对于已经发生或可能发生病理性骨折的病灶后采用单边支架外固定。于治疗后3，6，12个月进行X射线摄片观察，依据骨囊肿治疗标准Neer和Chigira X进行评价。评分Ⅰ级囊腔清晰大小无变化；评分Ⅱ级囊腔可见但呈多房模糊；评分Ⅲ级囊腔大部分硬化，仅遗留部分小囊腔；评分Ⅳ级囊腔消失，完全愈合。所有患者治疗后随防1-3年，平均随访时间为1.8年。8例患者切口均Ⅰ期愈合，愈合时间为4-8个月，平均6.2个月，未出现感染或皮缘坏死等并发症，X射线片病损区植骨均愈合，无骨不连发生，其中6例达到优(Ⅳ级)，2例达到良(Ⅲ级)，优良率100%；半螺纹钉松动1例，半螺纹钉道感染2例，经治疗痊愈，无创面感染，无断钉，无排斥反应，患肢功能恢复良好，无1例复发。长骨干动脉瘤样骨囊肿采用病灶局部开窗病灶腔内灭活，可以降低局部复发率，配合同种异体骨条植骨外固定支架，可以达到骨折的牢固固定，对治疗动脉瘤样骨囊肿及其病理性骨折有较好的临床效果。"

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