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Current Trends and Variations in the Treatment of Unicameral Bone Cysts of the Humerus: A Survey of EPOS and POSNA Members.

肱骨单房骨囊肿治疗的当前趋势和变化: EPOS和POSNA成员的调查。

  • 影响因子:1.69
  • DOI:10.1097/BPO.0000000000001376
  • 作者列表:"Farr S","Balacó IMS","Martínez-Alvarez S","Hahne J","Bae DS
  • 发表时间:2020-01-01
Abstract

BACKGROUND:A variety of treatment methods have so far been described for unicameral bone cysts (UBC). However, to the best of our knowledge, no particular consensus has yet been reached on when to operatively treat a patient with a humeral UBC. Therefore, members of the European Pediatric Orthopedic Society (EPOS) and Pediatric Orthopedic Society of North America (POSNA) were surveyed to characterize current treatment preferences. METHODS:An online electronic questionnaire was sent out to all registered EPOS and POSNA members. The survey comprised 45 questions related to the diagnosis, treatment, and follow-up characteristics of patients with UBCs of the humerus. Particular questions related to the nonoperative or surgical treatment of pathologic proximal humerus and humeral shaft fractures were also included. RESULTS:In total, 444 participants (132 EPOS and 292 POSNA members) responded, of whom 400 were actively involved in UBC treatment. The preferred diagnostic modalities to confirm the diagnosis of a UBC in the humerus were radiographs (88%), MRI in cases of questionable diagnosis (58%) or CT scan (8%). For painless UBCs 67% prefer no treatment at all except when the fracture risk is deemed high (then 53% recommend surgery); 71% of respondents would treat painful UBCs with surgery. Most common surgical techniques comprise curettage (45%), artificial bone substitutes (37%), corticosteroid injection (29%), or intramedullary stabilization (eg, rodding; 24%).Fractured, nondisplaced and mildly displaced proximal humerus UBCs and mildly displaced pathologic humerus shaft fractures are all preferably treated nonoperatively (94%, 91%, 83%, respectively). Severely displaced pathologic proximal humerus fractures are treated less often conservatively (36%) than surgically (40%), and severely displaced humerus shaft fractures are preferably treated surgically (63%) by intramedullary stabilization (60%). CONCLUSIONS:There is great variation among EPOS and POSNA members with regards to the diagnosis and treatment of UBCs in the humerus. Although some consensus on general treatment principles is seen, specific surgical treatment indications vary.Prospective randomized-controlled studies are needed to evaluate the outcomes of the different surgical approaches compared with nonoperative strategies. LEVEL OF EVIDENCE:Level V-expert opinion.

摘要

背景: 到目前为止,单房骨囊肿 (UBC) 有多种治疗方法。然而,据我们所知,何时手术治疗肱骨UBC患者尚未达成特别共识。因此,对欧洲儿科骨科学会 (EPOS) 和北美儿科骨科学会 (POSNA) 的成员进行了调查,以表征当前的治疗偏好。 方法: 向所有注册的EPOS和POSNA成员发出在线电子问卷。调查包括 45 个与肱骨UBCs患者的诊断、治疗和随访特征相关的问题。还包括与病理性肱骨近端和肱骨干骨折的非手术或手术治疗相关的特殊问题。 结果: 总共有 444 名参与者 (132 名epo和 292 名POSNA成员) 做出了回应,其中 400 积极参与UBC治疗。确定肱骨UBC诊断的首选诊断方式是x线片 (88%) 、可疑诊断病例的MRI (58%) 或ct扫描 (8%)。对于无痛UBCs,67% 的受访者除了骨折风险被认为较高外,根本不接受治疗 (53% 的受访者建议手术); 71% 的受访者会用手术治疗疼痛的UBCs。最常见的手术技术包括刮除术 (45%) 、人工骨替代物 (37%) 、皮质类固醇注射 (29%) 或髓内稳定 (例如,rodding; 24%)。骨折、无移位和轻度移位的肱骨近端UBCs和轻度移位的病理性肱骨干骨折均优选非手术治疗 (分别为 94% 、 91% 、 83%)。严重移位的病理性肱骨近端骨折的保守治疗 (36%) 少于手术治疗 (40%),严重移位的肱骨干骨折最好通过髓内稳定手术治疗 (63%) (60%)。 结论: 在肱骨内UBCs的诊断和治疗方面,EPOS和poisna成员之间存在很大差异。虽然对一般治疗原则有一些共识,但具体的手术治疗指征各不相同。需要前瞻性随机对照研究来评价不同手术入路与非手术策略相比的结果。 证据级别: V级-专家意见。

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影响因子:2.42
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DOI:10.1007/s12011-019-01715-5
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DOI:10.1007/s12011-019-01720-8
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囊肿方向

囊肿是一种良性疾病,它可以长在人体表面,也可以长在内脏里;囊肿就是长在体内某一脏器、囊状的良性包块,其内容物的性质是液态的。

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