四肢原发性动脉瘤样骨囊肿刮除术后复发因素分析
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摘要
目的分析四肢原发性动脉瘤样骨囊肿(aneurysmal bone cyst,ABC)行刮除术后复发的相关危险因素,为其临床治疗和降低复发率提供参考依据。方法收集2008年1月至2016年6月就诊的83例原发性ABC患者的相关资料,进行至少2年的随访,采用单因素分析、Kaplan-Meier无复发生存曲线分析和多因素Logistic回归分析的统计学方法,对可能的复发危险因素进行分析检验。结果 83病例中,复发15例(18.1%),复发时间为术后2～36个月,中位术后复发时间16个月。单因素分析和Kaplan-Meier法结果显示,年龄、术中高速磨钻的应用和不同充填方式可能影响四肢原发性ABC术后复发(P<0.05);多因素分析检验结果显示,年龄、术中是否采用高速磨钻为影响原发性ABC术后复发的独立因素(P<0.05),性别、病变部位及是否合并病理性骨折不影响术后复发(P>0.05)。结论对四肢原发性ABC患者行刮除术,年龄越小,复发率越高;术中采用高速磨钻辅助打磨可减低术后复发率。
Objective To analyze the risk factors for the recurrence after curettage of primary aneurysmal bone cysts(ABC) of the extremities,and to provide a reference for the clinical treatment and recurrence reduction.Methods The data of 83 primary ABC patients treated in our hospital between January 2008 and June 2016 were collected.Patients with followed up for at least 2 years.The possible risk factors for postoperative recurrence were analyzed using univariate analysis,Kaplan-Meier recurrence-free curves and multivariate logistic regression analysis.Results Of the 83 cases,recurrence occurred in 15(18.1%).The median postoperative recurrence time was 16 months(range,2 to 36 months).The results of univariate analysis and Kaplan-Meier curves showed that the age,filling methods and intraoperative high-speed burr might affect the postoperative recurrence of primary ABC of extremities(P<0.05).Multivariate analysis showed that the age and intraoperative high-speed burr were the independent factors affecting primary ABC recurrence(P<0.05).However,the gender,lesion location and presence of pathological fractures had no effects on postoperative recurrence(P>0.05).Conclusion The incidence of recurrence after curettage of primary ABC of the extremities is higher among younger patients.High-speed burr-assisted curettage can reduce the recurrence of ABC.
Objective To analyze the risk factors for the recurrence after curettage of primary aneurysmal bone cysts(ABC) of the extremities,and to provide a reference for the clinical treatment and recurrence reduction.Methods The data of 83 primary ABC patients treated in our hospital between January 2008 and June 2016 were collected.Patients with followed up for at least 2 years.The possible risk factors for postoperative recurrence were analyzed using univariate analysis,Kaplan-Meier recurrence-free curves and multivariate logistic regression analysis.Results Of the 83 cases,recurrence occurred in 15(18.1%).The median postoperative recurrence time was 16 months(range,2 to 36 months).The results of univariate analysis and Kaplan-Meier curves showed that the age,filling methods and intraoperative high-speed burr might affect the postoperative recurrence of primary ABC of extremities(P<0.05).Multivariate analysis showed that the age and intraoperative high-speed burr were the independent factors affecting primary ABC recurrence(P<0.05).However,the gender,lesion location and presence of pathological fractures had no effects on postoperative recurrence(P>0.05).Conclusion The incidence of recurrence after curettage of primary ABC of the extremities is higher among younger patients.High-speed burr-assisted curettage can reduce the recurrence of ABC.
引文
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[11] ULICI A,FLOREA D C,CARP M A,et al.Treatment of the aneurysmal bone cyst by percutaneous intracystic sclerotherapy using ethanol ninety five percent in children[J].Int Orthop,2018,42(6):1413-1419.
[12] MANKIN H J,HORNICEK F J,ORTIZ CRUZ E,et al.Aneurysmal bone cyst:a review of 150 patients[J].J Clin Oncol,2005,23(27):6756-6762.
[13] WANG E H M,MARFORI M L,SERRANO M V,et al.Is curettage and high-speed burring sufficient treatment for aneurysmal bone cysts?[J].Clin Orthop Relat Res,2014,472(11):3483-3488.
[14] KE?ECI B,Kü?üK L,ISAYEV A,et al.Effect of adjuvant therapies on recurrence in aneurysmal bone cysts[J].Acta Orthop Traumatol Turc,2014,48(5):500-506.
[15] COPLEY L,DORMANS J P.Benign pediatric bone tumors.Evaluation and treatment[J].Pediatr Clin North Am,1996,43(4):949-966.
[16] LIN P P,BROWN C,RAYMOND A K,et al.Aneurysmal bone cysts recur at juxtaphyseal locations in skeletally immature patients[J].Clin Orthop Relat Res,2008,466(3):722-728.
[17] BIESECKER J L,MARCOVE R C,HUVOS A G,et al.Aneurysmal bone cysts.A clinicopathologic study of 66 cases[J].Cancer,1970,26(3):615-625.
[18] SCHREUDER H W,VETH R P,PRUSZCZYNSKI M,et al.Aneurysmal bone cysts treated by curettage,cryotherapy and bone grafting[J].J Bone Joint Surg Br,1997,79(1):20-25.
[19] WALLACE M T,HENSHAW R M.Results of cement versus bone graft reconstruction after intralesional curettage of bone tumors in the skeletally immature patient[J].J Pediatr Orthop,2014,34(1):92-100.
[20] BA?ARIR K,PI?KIN A,Gü?Lü B,et al.Aneurysmal bone cyst recurrence in children:a review of 56 patients[J].J Pediatr Orthop,2007,27(8):938-943.
[2] ZEHETGRUBER H,BITTNER B,GRUBER D,et al.Prevalence of aneurysmal and solitary bone cysts in young patients[J].Clin Orthop Relat Res,2005,439:136-143.
[3] BORIANI S,LO S F,PUVANESARAJAH V A,et al.Aneurysmal bone cysts of the spine:treatment options and considerations[J].J Neurooncol,2014,120(1):171-178.
[4] MARTINEZ V,SISSONS H A.Aneurysmal bone cyst.A review of 123 cases including primary lesions and those secondary to other bone pathology[J].Cancer,1988,61(11):2291-2304.
[5] UNADKAT S,ADAMS A,RICHARDS P,et al.Paediatric aneurysmal bone cyst:not as easy as ABC[J].J Surg Case Rep,2018,2018(2):rjy008.
[6] FLORES I L,HAMILTON M E,ZANCHIN BALDISSERA E,et al.Simple and aneurismal bone cyst:Aspects of jaw pseudocysts basedon an experience of Brazilian pathology service during 53 years[J].Med Oral Patol Oral Cir Bucal,2017,22(1):e64-e69.
[7] AIBA H,KOBAYASHI M,WAGURI AGAYA Y,et al.Treatment of aneurysmal bone cysts using endoscopic curettage[J].BMC Musculoskelet Disord,2018,9(1):268.
[8] 孙扬,牛晓辉,王涛,等.原发动脉瘤样骨囊肿117例临床回顾分析[J].中国骨与关节外科,2013(3):204-208.
[9] HAUSCHILD O,LUEDEMANN M,ENGELHARDT M,et al.Aneurysmal bone cyst(ABC):treatment options and proposal of a follow-up regime[J].Acta Orthop Belg,2016,82(3):474-483.
[10] 张卫华,刘思源,张彦伟,等.动脉瘤样骨囊肿手术治疗效果[J].中国骨肿瘤骨病,2011,10(1):11-13.
[11] ULICI A,FLOREA D C,CARP M A,et al.Treatment of the aneurysmal bone cyst by percutaneous intracystic sclerotherapy using ethanol ninety five percent in children[J].Int Orthop,2018,42(6):1413-1419.
[12] MANKIN H J,HORNICEK F J,ORTIZ CRUZ E,et al.Aneurysmal bone cyst:a review of 150 patients[J].J Clin Oncol,2005,23(27):6756-6762.
[13] WANG E H M,MARFORI M L,SERRANO M V,et al.Is curettage and high-speed burring sufficient treatment for aneurysmal bone cysts?[J].Clin Orthop Relat Res,2014,472(11):3483-3488.
[14] KE?ECI B,Kü?üK L,ISAYEV A,et al.Effect of adjuvant therapies on recurrence in aneurysmal bone cysts[J].Acta Orthop Traumatol Turc,2014,48(5):500-506.
[15] COPLEY L,DORMANS J P.Benign pediatric bone tumors.Evaluation and treatment[J].Pediatr Clin North Am,1996,43(4):949-966.
[16] LIN P P,BROWN C,RAYMOND A K,et al.Aneurysmal bone cysts recur at juxtaphyseal locations in skeletally immature patients[J].Clin Orthop Relat Res,2008,466(3):722-728.
[17] BIESECKER J L,MARCOVE R C,HUVOS A G,et al.Aneurysmal bone cysts.A clinicopathologic study of 66 cases[J].Cancer,1970,26(3):615-625.
[18] SCHREUDER H W,VETH R P,PRUSZCZYNSKI M,et al.Aneurysmal bone cysts treated by curettage,cryotherapy and bone grafting[J].J Bone Joint Surg Br,1997,79(1):20-25.
[19] WALLACE M T,HENSHAW R M.Results of cement versus bone graft reconstruction after intralesional curettage of bone tumors in the skeletally immature patient[J].J Pediatr Orthop,2014,34(1):92-100.
[20] BA?ARIR K,PI?KIN A,Gü?Lü B,et al.Aneurysmal bone cyst recurrence in children:a review of 56 patients[J].J Pediatr Orthop,2007,27(8):938-943.