Torbiel kości – Rokowania, prognozy i postęp choroby

Torbiel kości
Rokowania, prognozy i postęp choroby

Rokowanie w torbielach kości, zwłaszcza torbieli jednokomorowej (UBC) i tętniakowatej (ABC), zależy od wielu czynników, takich jak lokalizacja, wielkość, aktywność torbieli oraz wiek pacjenta. UBC wykazuje spontaniczne ustępowanie, szczególnie po osiągnięciu dojrzałości szkieletowej, z 22% torbieli pozostających w stopniu II według skali Neera. Czynniki negatywne prognostycznie to duży rozmiar (>84,3 cm³), wielokomorowość, aktywność torbieli (bliskość chrząstki wzrostowej) oraz wiek <10 lat. Wskaźnik niepowodzenia leczenia różni się w zależności od metody: iniekcje steroidów 36,6%, gwoździowanie śródszpikowe 50%, a kombinacja obu metod 21,4%. Nawrót po leczeniu chirurgicznym wynosi 26,1%, a po leczeniu zachowawczym 27,3%. W przypadku ABC nawroty po wyłyżeczkowaniu sięgają 10-20%, z ryzykiem wzrostu u pacjentów <15 lat, z centralną lokalizacją torbieli i niepełnym usunięciem jamy torbielowatej.

Prognozy w torbielach kości (Bone cyst Prognosis)

Czynniki prognostyczne dla torbieli jednokomorowej (UBC)
Czynniki ryzyka nawrotu torbieli jednokomorowej
Wskaźniki niepowodzenia leczenia
Prognozy dla torbieli tętniakowatej (ABC)
Złozenia patologiczne i ich wpływ na rokowanie
Wskaźniki prognostyczne ryzyka złamania
Powikłania i ich prognozy
Wnioski dla rokowania i wyboru metody leczenia
Kolejne rozdziały

Prognozy w torbielach kości (Bone cyst Prognosis)

Rokowanie w przypadku torbieli kości zależy od wielu czynników, takich jak rodzaj torbieli, jej lokalizacja, wielkość, odpowiedź na leczenie oraz ryzyko powikłań. Większość torbieli kości ma charakter łagodny i nie wpływa na normalną funkcję kości, chociaż niektóre mogą nawracać po leczeniu lub prowadzić do złamania patologicznego bądź infekcji zajętej kości.¹

Czynniki prognostyczne dla torbieli jednokomorowej (UBC)

Torbiel jednokomorowa (UBC) rozwija się w metafizach kości i stopniowo oddala się od chrząstki wzrostowej. Charakterystyczną cechą jest jej spontaniczne ustępowanie, co tłumaczy rzadkość występowania u dorosłych. W prognozie UBC kluczowe znaczenie ma rozróżnienie między torbielami aktywnymi a nieaktywnymi. Torbiele aktywne znajdują się bardzo blisko chrząstki wzrostowej, podczas gdy nieaktywne oddaliły się od strefy wzrostu lub nie mają z nią bezpośredniego kontaktu.²

Wskaźnik niepowodzenia leczenia jest znacząco wyższy u pacjentów z aktywną torbielą kostną, niezależnie od zastosowanej metody leczenia i lokalizacji torbieli (p<0,03).³⁴ U większości dzieci z torbielą jednokomorową w momencie osiągnięcia dojrzałości szkieletowej torbiele są całkowicie wyleczone, tylko 22% torbieli klasyfikowanych jest jako stopień II według skali Neera.⁵

Czynniki ryzyka nawrotu torbieli jednokomorowej

Negatywne czynniki prognostyczne zwiększające ryzyko nawrotu po leczeniu przezskórnym torbieli jednokomorowej obejmują:⁶

Duży rozmiar torbieli
Wielokomorowość
Aktywność torbieli (bliskość chrząstki wzrostowej)
Wiek poniżej 10 lat

⁷

Objętość torbieli koreluje ze wskaźnikiem gojenia. Jeśli objętość torbieli wynosi 84,3 cm³ lub więcej, wskaźnik gojenia jest znacząco zmniejszony w porównaniu z wszystkimi grupami (p<0,03).⁸ Wskaźnik torbieli w momencie diagnozy wykazuje także istotny związek ze wskaźnikiem gojenia.⁹

Wskaźniki niepowodzenia leczenia

Wskaźniki niepowodzenia leczenia różnią się w zależności od zastosowanej metody terapeutycznej:¹⁰

Iniekcje steroidów: 36,6% niepowodzeń
Gwoździowanie śródszpikowe: 50% niepowodzeń
Gwoździowanie śródszpikowe w połączeniu ze steroidami: 21,4% niepowodzeń
Pozostałe metody: brak niepowodzeń

¹¹

Ogólny wskaźnik nawrotów po pierwotnej terapii chirurgicznej wynosił 26,1% (31/119) dla wszystkich zabiegów chirurgicznych, przy czym nawrót definiowano jako konieczność dalszego leczenia chirurgicznego z powodu ponownego złamania, stopnia III/IV według Neera, ograniczonej funkcji lub utrzymującego się bólu.¹²¹³ W przypadku leczenia zachowawczego wskaźnik niepowodzeń wynosił 27,3% (6 z 22).¹⁴¹⁵

Prognozy dla torbieli tętniakowatej (ABC)

W przypadku torbieli tętniakowatej (ABC) wskaźnik nawrotów po wyłyżeczkowaniu wynosi około 10-20%. Zidentyfikowano następujące czynniki ryzyka nawrotu:¹⁶

Wiek poniżej 15 lat
Centralna lokalizacja torbieli
Niekompletne usunięcie jamy torbielowatej

¹⁷

Złozenia patologiczne i ich wpływ na rokowanie

Interesującym aspektem prognostycznym jest fakt, że torbiel kostna rzadko goi się samoistnie po złamaniu patologicznym. Mimo że początkowo może tworzyć się obfity kostniny, zwykle ulega ona resorpcji po 6 miesiącach, a prawdopodobieństwo wygojenia torbieli po złamaniu jest niskie.¹⁸ Co więcej, Neer stwierdził, że u 70% pacjentów z torbielami dochodziło do kolejnego złamania w ciągu 2 lat.¹⁹

Badacze próbowali zidentyfikować cechy pacjentów i/lub torbieli, które pozwalają przewidzieć wyniki leczenia. Badano wiele czynników, w tym między innymi wielkość i lokalizację torbieli, objawy, wcześniejsze złamania, wiek pacjenta, płeć, rodzaje interwencji oraz długość okresu obserwacji.²⁰

Wskaźniki prognostyczne ryzyka złamania

Kaelin donosi, że u 40 pacjentów, którzy mieli wskaźnik torbieli niższy niż 3,5 i nie ograniczali swojej aktywności, nie wystąpiły złamania.²¹ Torbiele z co najmniej dwoma kolejnymi zmniejszonymi wskaźnikami wynoszącymi 3 oraz ścianą korową grubszą niż 2 mm uznawane są za wyleczone. Gdy te warunki są spełnione, złamania nigdy nie występują, a wynik leczenia jest zawsze korzystny.²²

Jednak niedawne badanie zakwestionowało wiarygodność wskaźnika torbieli jako predyktora złamania.²³ Ahn i Park przeprowadzili retrospektywny przegląd 75 dzieci z torbielą jednokomorową, aby określić, które torbiele mogą być obarczone ryzykiem i czy gojenie przyspiesza po złamaniu.²⁴

W konkluzji, ilościowa tomografia komputerowa może być najdokładniejszą metodą prognozowania złamania, ale nawet ta metoda ma zarówno wyniki fałszywie dodatnie, jak i fałszywie ujemne, a także wiąże się z ryzykiem związanym z promieniowaniem jonizującym.²⁵

Powikłania i ich prognozy

U większości dzieci torbiele objawiają się bólem spowodowanym złamaniami patologicznymi. Możliwe powikłania obejmują:²⁶

Zaburzenia wzrostu – mogą wystąpić z powodu nacisku torbieli na chrząstkę wzrostową, jako powikłanie leczenia torbieli w pobliżu chrząstki wzrostowej lub złamania przez torbiel szyjki kości udowej
Nierówność długości kończyn i deformacje wynikające z wyżej wymienionych przyczyn
Martwica – szczególnie w przypadku złamania przez torbiel szyjki kości udowej

²⁷

Nie zaobserwowano istotnych różnic między grupami leczenia w odniesieniu do wtórnych złamań, funkcji, bólu lub powikłań.²⁸ Dodatkowo, nie obserwowano nawrotu torbieli po jej całkowitym wygojeniu (stopień I według Neera).²⁹

Wnioski dla rokowania i wyboru metody leczenia

Wybór metody leczenia powinien uwzględniać bilans między inwazyjnością procedury a potrzebą powtarzania leczenia (np. iniekcje steroidów). Czynniki te należy równoważyć z ryzykiem złamania i prawdopodobieństwem powodzenia leczenia.³⁰³¹

Iniekcja steroidów pozostaje niezawodną metodą leczenia torbieli kostnych pojedynczych ze względu na jej niską inwazyjność.³² Aby zapobiec złamaniom i umożliwić pełne obciążanie, stabilizacja wewnętrzna w połączeniu z iniekcjami octanu metyloprednisolonu wydaje się być najbardziej korzystna w kościach nośnych.³³

Bezobjawowe zmiany o niskim ryzyku złamań patologicznych oraz nieaktywne torbiele zazwyczaj pozostawia się bez interwencji. Łyżeczkowanie i przeszczep kostny z wewnętrzną stabilizacją są zarezerwowane dla większych, objawowych zmian w obszarach wysokiego ryzyka, takich jak kość udowa.³⁴

Kolejne rozdziały

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Materiały źródłowe

#1 Bone Cysts | Maguire & Early Orthopedics, Pediatric Orthopedic Surgeons, Santa Barbara, Pismo Beach, CA
https://www.maguireearlyorthopedics.com/bone-cysts-pediatric-orthopaedic-trauma-surgeon-santa-barbara-pismo-beach-ca/
The prognosis for a bone cyst depends on many factors, such as the type and size of the cyst, the response to treatment and the risk of complications. Most bone cysts are benign and do not affect the normal function of the bone. However, some bone cysts may recur after treatment or cause a fracture or infection of the affected bone.
#2 Bone Cyst – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK539849/
UBC: UBC develops in the metaphysis and gradually grows away from the physis. It is known for spontaneous resolution, as evidenced by its rareness in adults. […] Active cysts are very near the growth plate, while inactive cysts have grown away from growth or are not in direct contact with the growth plate. High-risk areas are those that may lead to significant disability, like a femur neck cyst, which, if fractured, may lead to necrosis and limb length discrepancy. Asymptomatic lesions with a low risk for pathological fractures/inactive cysts are usually left alone. Most children present with pain due to pathological fractures through cysts. Growth discrepancy may occur due to cyst pressure into growth plates, as a complication of cyst treatment near the growth plate, or a fracture through a femoral neck cyst. All these may cause limb length discrepancy and deformities. Hence, the appropriate treatment protocol is crucial for the management of cysts. Curettage and bone grafting with internal fixation are reserved for larger, symptomatic lesions in high-risk areas like the femur. Other lesions are treated with percutaneous injections, as described above. Poor prognostic factors for recurrence following percutaneous treatment include large size, multilocation, active lesions, and age younger than 10.
#3 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1012-0
The objective of therapy is to prevent a pathologic fracture or re-fracture, promote cyst healing, and to avoid cyst recurrence. […] The primary study outcome was the cyst-healing and the secondary outcome included the function and activity, pain, subsequent fractures, and complications. […] The failure rate in the conservative group was 27.3 % (6 of 22). Overall recurrence rate after primary surgical therapy was 26.1 % (31/119) for all surgical procedures – recurrence being defined as requiring further surgical treatment (re-fracture, grade III/IV, limited function or ongoing pain). […] The failure rate was significantly higher in patients with an active bone cyst, independent from treatment and location. […] We did not see a cyst recurrence after the cyst was completely healed (Neer Grade I).
#4 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome
https://pmc.ncbi.nlm.nih.gov/articles/PMC4831090/
The cyst volume found to be related to healing rate. If the cyst volume was 84.3 cm3 the healing rate for the SBC was significantly reduced in comparison of all the groups (p0.03). […] The cyst index at diagnosis showed a significant relation to the healing rate. […] The failure rate was significantly higher in patients with an active bone cyst, independent from treatment and location (p0.03). […] We believe that the invasiveness of the procedure must be contrasted by the need for repeated treatment (e.g. steroids). These factors must be balanced against risk of fracture and probability of success rate.
#5 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1012-0
At the time the patient reached skeletal maturity the majority of the SBC were healed completely, only 22 % of the SBC were classified Grade II. […] We believe that the invasiveness of the procedure must be contrasted by the need for repeated treatment (e.g. steroids). […] These factors must be balanced against risk of fracture and probability of success rate.
#6 Bone Cyst – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK539849/
UBC: UBC develops in the metaphysis and gradually grows away from the physis. It is known for spontaneous resolution, as evidenced by its rareness in adults. […] Active cysts are very near the growth plate, while inactive cysts have grown away from growth or are not in direct contact with the growth plate. High-risk areas are those that may lead to significant disability, like a femur neck cyst, which, if fractured, may lead to necrosis and limb length discrepancy. Asymptomatic lesions with a low risk for pathological fractures/inactive cysts are usually left alone. Most children present with pain due to pathological fractures through cysts. Growth discrepancy may occur due to cyst pressure into growth plates, as a complication of cyst treatment near the growth plate, or a fracture through a femoral neck cyst. All these may cause limb length discrepancy and deformities. Hence, the appropriate treatment protocol is crucial for the management of cysts. Curettage and bone grafting with internal fixation are reserved for larger, symptomatic lesions in high-risk areas like the femur. Other lesions are treated with percutaneous injections, as described above. Poor prognostic factors for recurrence following percutaneous treatment include large size, multilocation, active lesions, and age younger than 10.
#7 Bone Cyst – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK539849/
UBC: UBC develops in the metaphysis and gradually grows away from the physis. It is known for spontaneous resolution, as evidenced by its rareness in adults. […] Active cysts are very near the growth plate, while inactive cysts have grown away from growth or are not in direct contact with the growth plate. High-risk areas are those that may lead to significant disability, like a femur neck cyst, which, if fractured, may lead to necrosis and limb length discrepancy. Asymptomatic lesions with a low risk for pathological fractures/inactive cysts are usually left alone. Most children present with pain due to pathological fractures through cysts. Growth discrepancy may occur due to cyst pressure into growth plates, as a complication of cyst treatment near the growth plate, or a fracture through a femoral neck cyst. All these may cause limb length discrepancy and deformities. Hence, the appropriate treatment protocol is crucial for the management of cysts. Curettage and bone grafting with internal fixation are reserved for larger, symptomatic lesions in high-risk areas like the femur. Other lesions are treated with percutaneous injections, as described above. Poor prognostic factors for recurrence following percutaneous treatment include large size, multilocation, active lesions, and age younger than 10.
#8 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome
https://pmc.ncbi.nlm.nih.gov/articles/PMC4831090/
The cyst volume found to be related to healing rate. If the cyst volume was 84.3 cm3 the healing rate for the SBC was significantly reduced in comparison of all the groups (p0.03). […] The cyst index at diagnosis showed a significant relation to the healing rate. […] The failure rate was significantly higher in patients with an active bone cyst, independent from treatment and location (p0.03). […] We believe that the invasiveness of the procedure must be contrasted by the need for repeated treatment (e.g. steroids). These factors must be balanced against risk of fracture and probability of success rate.
#9 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome
https://pmc.ncbi.nlm.nih.gov/articles/PMC4831090/
The cyst volume found to be related to healing rate. If the cyst volume was 84.3 cm3 the healing rate for the SBC was significantly reduced in comparison of all the groups (p0.03). […] The cyst index at diagnosis showed a significant relation to the healing rate. […] The failure rate was significantly higher in patients with an active bone cyst, independent from treatment and location (p0.03). […] We believe that the invasiveness of the procedure must be contrasted by the need for repeated treatment (e.g. steroids). These factors must be balanced against risk of fracture and probability of success rate.
#10 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1012-0
Solitary bone cysts (SBC) are benign, tumor-like lesions, which most frequently occur in the proximal metaphyseal-diaphyseal region of the humerus and femur of children and adolescents. […] The purpose of this study was to evaluate the effectiveness and the longterm clinical outcome of the treatment of SBC. […] There was no significant difference between the treatment groups with respect to secondary fractures, function, pain, or complications. […] The failure rate after initial treatment was 36.6 % with steroids, 50 % with intramedullary nailing, 21.4 % with intramedullary nailing plus steroids and none in the remaining group. […] Steroid injection remains a reliable method for treating solitary bone cysts owing to its low invasiveness. […] To prevent fractures and allow a full weight bearing, internal fixation in combination with methylprednisolon acetat injections seems to be the most favorable in weight bearing bones.
#11 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1012-0
Solitary bone cysts (SBC) are benign, tumor-like lesions, which most frequently occur in the proximal metaphyseal-diaphyseal region of the humerus and femur of children and adolescents. […] The purpose of this study was to evaluate the effectiveness and the longterm clinical outcome of the treatment of SBC. […] There was no significant difference between the treatment groups with respect to secondary fractures, function, pain, or complications. […] The failure rate after initial treatment was 36.6 % with steroids, 50 % with intramedullary nailing, 21.4 % with intramedullary nailing plus steroids and none in the remaining group. […] Steroid injection remains a reliable method for treating solitary bone cysts owing to its low invasiveness. […] To prevent fractures and allow a full weight bearing, internal fixation in combination with methylprednisolon acetat injections seems to be the most favorable in weight bearing bones.
#12 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1012-0
The objective of therapy is to prevent a pathologic fracture or re-fracture, promote cyst healing, and to avoid cyst recurrence. […] The primary study outcome was the cyst-healing and the secondary outcome included the function and activity, pain, subsequent fractures, and complications. […] The failure rate in the conservative group was 27.3 % (6 of 22). Overall recurrence rate after primary surgical therapy was 26.1 % (31/119) for all surgical procedures – recurrence being defined as requiring further surgical treatment (re-fracture, grade III/IV, limited function or ongoing pain). […] The failure rate was significantly higher in patients with an active bone cyst, independent from treatment and location. […] We did not see a cyst recurrence after the cyst was completely healed (Neer Grade I).
#13 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome
https://pmc.ncbi.nlm.nih.gov/articles/PMC4831090/
Solitary bone cysts (SBC) are benign, tumor-like lesions, which most frequently occur in the proximal metaphyseal-diaphyseal region of the humerus and femur of children and adolescents. The purpose of this study was to evaluate the effectiveness and the longterm clinical outcome of the treatment of SBC. […] The objective of therapy is to prevent a pathologic fracture or re-fracture, promote cyst healing, and to avoid cyst recurrence. […] The primary study outcome was the cyst-healing and the secondary outcome included the function and activity, pain, subsequent fractures, and complications. […] The failure rate in the conservative group was 27.3 % (6 of 22). Overall recurrence rate after primary surgical therapy was 26.1 % (31/119) for all surgical procedures – recurrence being defined as requiring further surgical treatment (re-fracture, grade III/IV, limited function or ongoing pain).
#14 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1012-0
The objective of therapy is to prevent a pathologic fracture or re-fracture, promote cyst healing, and to avoid cyst recurrence. […] The primary study outcome was the cyst-healing and the secondary outcome included the function and activity, pain, subsequent fractures, and complications. […] The failure rate in the conservative group was 27.3 % (6 of 22). Overall recurrence rate after primary surgical therapy was 26.1 % (31/119) for all surgical procedures – recurrence being defined as requiring further surgical treatment (re-fracture, grade III/IV, limited function or ongoing pain). […] The failure rate was significantly higher in patients with an active bone cyst, independent from treatment and location. […] We did not see a cyst recurrence after the cyst was completely healed (Neer Grade I).
#15 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome
https://pmc.ncbi.nlm.nih.gov/articles/PMC4831090/
Solitary bone cysts (SBC) are benign, tumor-like lesions, which most frequently occur in the proximal metaphyseal-diaphyseal region of the humerus and femur of children and adolescents. The purpose of this study was to evaluate the effectiveness and the longterm clinical outcome of the treatment of SBC. […] The objective of therapy is to prevent a pathologic fracture or re-fracture, promote cyst healing, and to avoid cyst recurrence. […] The primary study outcome was the cyst-healing and the secondary outcome included the function and activity, pain, subsequent fractures, and complications. […] The failure rate in the conservative group was 27.3 % (6 of 22). Overall recurrence rate after primary surgical therapy was 26.1 % (31/119) for all surgical procedures – recurrence being defined as requiring further surgical treatment (re-fracture, grade III/IV, limited function or ongoing pain).
#16 Bone Cyst – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK539849/
ABC: The recurrence rate after curettage of ABC is approximately 10 to 20%. Age younger than 15 years, central location, and incomplete removal of the cystic cavity are known risk factors for recurrence. Complete surgical resection is reserved for more dispensible bones like the clavicle and fibula, where partial bone excision does not cause any significant long-term morbidity.
#17 Bone Cyst – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK539849/
ABC: The recurrence rate after curettage of ABC is approximately 10 to 20%. Age younger than 15 years, central location, and incomplete removal of the cystic cavity are known risk factors for recurrence. Complete surgical resection is reserved for more dispensible bones like the clavicle and fibula, where partial bone excision does not cause any significant long-term morbidity.
#18 Evidence-Based Treatment of Simple Bone Cyst | Musculoskeletal Key
https://musculoskeletalkey.com/evidence-based-treatment-of-simple-bone-cyst/
A simple bone cyst seldom heals after a pathological fracture. While abundant callous may initially form, it tends to resorb after 6 months and there is a low likelihood of the cyst healing following a fracture. […] Moreover, Neer found 70 % of the cysts developed another fracture within 2 years. […] Researchers have been trying to identify patients and/or cyst features that predict outcomes in SBC. Several factors were investigated including but not limited to the size and site of the cyst, symptoms, previous fractures, patients age, sex, types of interventions and length of follow-up. […] Kaelin reported that there were no fractures in 40 patients who had an index lower than 3.5 and who did not curtail their activities. […] Cysts with at least two consecutive decreased indices of 3 and a cortical wall thicker 2 mm are considered to be healed. When these conditions are present, fractures never occur and the result is always favourable.
#19 Evidence-Based Treatment of Simple Bone Cyst | Musculoskeletal Key
https://musculoskeletalkey.com/evidence-based-treatment-of-simple-bone-cyst/
A simple bone cyst seldom heals after a pathological fracture. While abundant callous may initially form, it tends to resorb after 6 months and there is a low likelihood of the cyst healing following a fracture. […] Moreover, Neer found 70 % of the cysts developed another fracture within 2 years. […] Researchers have been trying to identify patients and/or cyst features that predict outcomes in SBC. Several factors were investigated including but not limited to the size and site of the cyst, symptoms, previous fractures, patients age, sex, types of interventions and length of follow-up. […] Kaelin reported that there were no fractures in 40 patients who had an index lower than 3.5 and who did not curtail their activities. […] Cysts with at least two consecutive decreased indices of 3 and a cortical wall thicker 2 mm are considered to be healed. When these conditions are present, fractures never occur and the result is always favourable.
#20 Evidence-Based Treatment of Simple Bone Cyst | Musculoskeletal Key
https://musculoskeletalkey.com/evidence-based-treatment-of-simple-bone-cyst/
A simple bone cyst seldom heals after a pathological fracture. While abundant callous may initially form, it tends to resorb after 6 months and there is a low likelihood of the cyst healing following a fracture. […] Moreover, Neer found 70 % of the cysts developed another fracture within 2 years. […] Researchers have been trying to identify patients and/or cyst features that predict outcomes in SBC. Several factors were investigated including but not limited to the size and site of the cyst, symptoms, previous fractures, patients age, sex, types of interventions and length of follow-up. […] Kaelin reported that there were no fractures in 40 patients who had an index lower than 3.5 and who did not curtail their activities. […] Cysts with at least two consecutive decreased indices of 3 and a cortical wall thicker 2 mm are considered to be healed. When these conditions are present, fractures never occur and the result is always favourable.
#21 Evidence-Based Treatment of Simple Bone Cyst | Musculoskeletal Key
https://musculoskeletalkey.com/evidence-based-treatment-of-simple-bone-cyst/
A simple bone cyst seldom heals after a pathological fracture. While abundant callous may initially form, it tends to resorb after 6 months and there is a low likelihood of the cyst healing following a fracture. […] Moreover, Neer found 70 % of the cysts developed another fracture within 2 years. […] Researchers have been trying to identify patients and/or cyst features that predict outcomes in SBC. Several factors were investigated including but not limited to the size and site of the cyst, symptoms, previous fractures, patients age, sex, types of interventions and length of follow-up. […] Kaelin reported that there were no fractures in 40 patients who had an index lower than 3.5 and who did not curtail their activities. […] Cysts with at least two consecutive decreased indices of 3 and a cortical wall thicker 2 mm are considered to be healed. When these conditions are present, fractures never occur and the result is always favourable.
#22 Evidence-Based Treatment of Simple Bone Cyst | Musculoskeletal Key
https://musculoskeletalkey.com/evidence-based-treatment-of-simple-bone-cyst/
A simple bone cyst seldom heals after a pathological fracture. While abundant callous may initially form, it tends to resorb after 6 months and there is a low likelihood of the cyst healing following a fracture. […] Moreover, Neer found 70 % of the cysts developed another fracture within 2 years. […] Researchers have been trying to identify patients and/or cyst features that predict outcomes in SBC. Several factors were investigated including but not limited to the size and site of the cyst, symptoms, previous fractures, patients age, sex, types of interventions and length of follow-up. […] Kaelin reported that there were no fractures in 40 patients who had an index lower than 3.5 and who did not curtail their activities. […] Cysts with at least two consecutive decreased indices of 3 and a cortical wall thicker 2 mm are considered to be healed. When these conditions are present, fractures never occur and the result is always favourable.
#23 Evidence-Based Treatment of Simple Bone Cyst | Musculoskeletal Key
https://musculoskeletalkey.com/evidence-based-treatment-of-simple-bone-cyst/
A recent study questioned the reliability of the cyst index as a predictor of fracture. […] Ahn and Park carried out a retrospective review of 75 children with SBC to determine which cysts were likely to be at risk and whether healing was accelerated after a fracture. […] In conclusion, quantitative CT may be the most accurate method of predicting fracture but even this method has false positives and false negatives and does involve risks associated with ionising radiation.
#24 Evidence-Based Treatment of Simple Bone Cyst | Musculoskeletal Key
https://musculoskeletalkey.com/evidence-based-treatment-of-simple-bone-cyst/
A recent study questioned the reliability of the cyst index as a predictor of fracture. […] Ahn and Park carried out a retrospective review of 75 children with SBC to determine which cysts were likely to be at risk and whether healing was accelerated after a fracture. […] In conclusion, quantitative CT may be the most accurate method of predicting fracture but even this method has false positives and false negatives and does involve risks associated with ionising radiation.
#25 Evidence-Based Treatment of Simple Bone Cyst | Musculoskeletal Key
https://musculoskeletalkey.com/evidence-based-treatment-of-simple-bone-cyst/
A recent study questioned the reliability of the cyst index as a predictor of fracture. […] Ahn and Park carried out a retrospective review of 75 children with SBC to determine which cysts were likely to be at risk and whether healing was accelerated after a fracture. […] In conclusion, quantitative CT may be the most accurate method of predicting fracture but even this method has false positives and false negatives and does involve risks associated with ionising radiation.
#26 Bone Cyst – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK539849/
UBC: UBC develops in the metaphysis and gradually grows away from the physis. It is known for spontaneous resolution, as evidenced by its rareness in adults. […] Active cysts are very near the growth plate, while inactive cysts have grown away from growth or are not in direct contact with the growth plate. High-risk areas are those that may lead to significant disability, like a femur neck cyst, which, if fractured, may lead to necrosis and limb length discrepancy. Asymptomatic lesions with a low risk for pathological fractures/inactive cysts are usually left alone. Most children present with pain due to pathological fractures through cysts. Growth discrepancy may occur due to cyst pressure into growth plates, as a complication of cyst treatment near the growth plate, or a fracture through a femoral neck cyst. All these may cause limb length discrepancy and deformities. Hence, the appropriate treatment protocol is crucial for the management of cysts. Curettage and bone grafting with internal fixation are reserved for larger, symptomatic lesions in high-risk areas like the femur. Other lesions are treated with percutaneous injections, as described above. Poor prognostic factors for recurrence following percutaneous treatment include large size, multilocation, active lesions, and age younger than 10.
#27 Bone Cyst – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK539849/
UBC: UBC develops in the metaphysis and gradually grows away from the physis. It is known for spontaneous resolution, as evidenced by its rareness in adults. […] Active cysts are very near the growth plate, while inactive cysts have grown away from growth or are not in direct contact with the growth plate. High-risk areas are those that may lead to significant disability, like a femur neck cyst, which, if fractured, may lead to necrosis and limb length discrepancy. Asymptomatic lesions with a low risk for pathological fractures/inactive cysts are usually left alone. Most children present with pain due to pathological fractures through cysts. Growth discrepancy may occur due to cyst pressure into growth plates, as a complication of cyst treatment near the growth plate, or a fracture through a femoral neck cyst. All these may cause limb length discrepancy and deformities. Hence, the appropriate treatment protocol is crucial for the management of cysts. Curettage and bone grafting with internal fixation are reserved for larger, symptomatic lesions in high-risk areas like the femur. Other lesions are treated with percutaneous injections, as described above. Poor prognostic factors for recurrence following percutaneous treatment include large size, multilocation, active lesions, and age younger than 10.
#28 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1012-0
Solitary bone cysts (SBC) are benign, tumor-like lesions, which most frequently occur in the proximal metaphyseal-diaphyseal region of the humerus and femur of children and adolescents. […] The purpose of this study was to evaluate the effectiveness and the longterm clinical outcome of the treatment of SBC. […] There was no significant difference between the treatment groups with respect to secondary fractures, function, pain, or complications. […] The failure rate after initial treatment was 36.6 % with steroids, 50 % with intramedullary nailing, 21.4 % with intramedullary nailing plus steroids and none in the remaining group. […] Steroid injection remains a reliable method for treating solitary bone cysts owing to its low invasiveness. […] To prevent fractures and allow a full weight bearing, internal fixation in combination with methylprednisolon acetat injections seems to be the most favorable in weight bearing bones.
#29 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1012-0
The objective of therapy is to prevent a pathologic fracture or re-fracture, promote cyst healing, and to avoid cyst recurrence. […] The primary study outcome was the cyst-healing and the secondary outcome included the function and activity, pain, subsequent fractures, and complications. […] The failure rate in the conservative group was 27.3 % (6 of 22). Overall recurrence rate after primary surgical therapy was 26.1 % (31/119) for all surgical procedures – recurrence being defined as requiring further surgical treatment (re-fracture, grade III/IV, limited function or ongoing pain). […] The failure rate was significantly higher in patients with an active bone cyst, independent from treatment and location. […] We did not see a cyst recurrence after the cyst was completely healed (Neer Grade I).
#30 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1012-0
At the time the patient reached skeletal maturity the majority of the SBC were healed completely, only 22 % of the SBC were classified Grade II. […] We believe that the invasiveness of the procedure must be contrasted by the need for repeated treatment (e.g. steroids). […] These factors must be balanced against risk of fracture and probability of success rate.
#31 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome
https://pmc.ncbi.nlm.nih.gov/articles/PMC4831090/
The cyst volume found to be related to healing rate. If the cyst volume was 84.3 cm3 the healing rate for the SBC was significantly reduced in comparison of all the groups (p0.03). […] The cyst index at diagnosis showed a significant relation to the healing rate. […] The failure rate was significantly higher in patients with an active bone cyst, independent from treatment and location (p0.03). […] We believe that the invasiveness of the procedure must be contrasted by the need for repeated treatment (e.g. steroids). These factors must be balanced against risk of fracture and probability of success rate.
#32 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1012-0
Solitary bone cysts (SBC) are benign, tumor-like lesions, which most frequently occur in the proximal metaphyseal-diaphyseal region of the humerus and femur of children and adolescents. […] The purpose of this study was to evaluate the effectiveness and the longterm clinical outcome of the treatment of SBC. […] There was no significant difference between the treatment groups with respect to secondary fractures, function, pain, or complications. […] The failure rate after initial treatment was 36.6 % with steroids, 50 % with intramedullary nailing, 21.4 % with intramedullary nailing plus steroids and none in the remaining group. […] Steroid injection remains a reliable method for treating solitary bone cysts owing to its low invasiveness. […] To prevent fractures and allow a full weight bearing, internal fixation in combination with methylprednisolon acetat injections seems to be the most favorable in weight bearing bones.
#33 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1012-0
Solitary bone cysts (SBC) are benign, tumor-like lesions, which most frequently occur in the proximal metaphyseal-diaphyseal region of the humerus and femur of children and adolescents. […] The purpose of this study was to evaluate the effectiveness and the longterm clinical outcome of the treatment of SBC. […] There was no significant difference between the treatment groups with respect to secondary fractures, function, pain, or complications. […] The failure rate after initial treatment was 36.6 % with steroids, 50 % with intramedullary nailing, 21.4 % with intramedullary nailing plus steroids and none in the remaining group. […] Steroid injection remains a reliable method for treating solitary bone cysts owing to its low invasiveness. […] To prevent fractures and allow a full weight bearing, internal fixation in combination with methylprednisolon acetat injections seems to be the most favorable in weight bearing bones.
#34 Bone Cyst – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK539849/
UBC: UBC develops in the metaphysis and gradually grows away from the physis. It is known for spontaneous resolution, as evidenced by its rareness in adults. […] Active cysts are very near the growth plate, while inactive cysts have grown away from growth or are not in direct contact with the growth plate. High-risk areas are those that may lead to significant disability, like a femur neck cyst, which, if fractured, may lead to necrosis and limb length discrepancy. Asymptomatic lesions with a low risk for pathological fractures/inactive cysts are usually left alone. Most children present with pain due to pathological fractures through cysts. Growth discrepancy may occur due to cyst pressure into growth plates, as a complication of cyst treatment near the growth plate, or a fracture through a femoral neck cyst. All these may cause limb length discrepancy and deformities. Hence, the appropriate treatment protocol is crucial for the management of cysts. Curettage and bone grafting with internal fixation are reserved for larger, symptomatic lesions in high-risk areas like the femur. Other lesions are treated with percutaneous injections, as described above. Poor prognostic factors for recurrence following percutaneous treatment include large size, multilocation, active lesions, and age younger than 10.