Abstract：
BACKGROUND: Aneurysmal bone cysts (ABC) are rare benign cystic bone tumors, generally diagnosed in children and adolescents. Proximal femoral ABCs may require specific treatment strategies because of an increased pathologic fracture risk. As few reports are published on ABCs, specifically for this localization, consensus regarding optimal treatment is lacking. We present a large retrospective study on the treatment of pediatric proximal femoral ABCs.
METHODS: All eligible pediatric patients with proximal femoral ABC were included, from 11 tertiary referral centers for musculo-skeletal oncology (2000-2021). Patient demographics, diagnostics, treatments, and complications were evaluated. Index procedures were categorized as percutaneous/open procedures and osteosynthesis alone. Primary outcomes were: time until full weight-bearing and failure-free survival. Failure was defined as open procedure after primary surgery, >3 percutaneous procedures, recurrence, and/or fracture. Risk factors for failure were evaluated.
RESULTS: Seventy-nine patients with ABC were included [mean age, 10.2 (±SD4.0) y, n=56 male]. The median follow-up was 5.1 years (interquartile ranges=2.5 to 8.8).Index procedure was percutaneous procedure (n=22), open procedure (n=35), or osteosynthesis alone (n=22). The median time until full weight-bearing was 13 weeks [95% confidence interval (CI)=7.9-18.1] for open procedures, 9 weeks (95% CI=1.4-16.6) for percutaneous, and 6 weeks (95% CI=4.3-7.7) for osteosynthesis alone ( P =0.1). Failure rates were 41%, 43%, and 36%, respectively. Overall, 2 and 5-year failure-free survival was 69.6% (95% CI=59.2-80.0) and 54.5% (95% CI=41.6-67.4), respectively. Risk factors associated with failure were age younger than 10 years [hazard ratios (HR)=2.9, 95% CI=1.4-5.8], cyst volume >55 cm 3 (HR=1.7, 95% CI=0.8-2.5), and fracture at diagnosis (HR=1.4, 95% CI=0.7-3.3).
CONCLUSIONS: As both open and percutaneous procedures along with osteosynthesis alone seem viable treatment options in this weight-bearing location, optimal treatment for proximal femoral ABCs remains unclear. The aim of the treatment was to achieve local cyst control while minimizing complications and ensuring that children can continue their normal activities as soon as possible. A personalized balance should be maintained between undertreatment, with potentially higher risks of pathologic fractures, prolonged periods of partial weight-bearing, or recurrences, versus overtreatment with large surgical procedures, and associated risks.
METHODS: Level IV, therapeutic study.
METHODS: All eligible pediatric patients with proximal femoral ABC were included, from 11 tertiary referral centers for musculo-skeletal oncology (2000-2021). Patient demographics, diagnostics, treatments, and complications were evaluated. Index procedures were categorized as percutaneous/open procedures and osteosynthesis alone. Primary outcomes were: time until full weight-bearing and failure-free survival. Failure was defined as open procedure after primary surgery, >3 percutaneous procedures, recurrence, and/or fracture. Risk factors for failure were evaluated.
RESULTS: Seventy-nine patients with ABC were included [mean age, 10.2 (±SD4.0) y, n=56 male]. The median follow-up was 5.1 years (interquartile ranges=2.5 to 8.8).Index procedure was percutaneous procedure (n=22), open procedure (n=35), or osteosynthesis alone (n=22). The median time until full weight-bearing was 13 weeks [95% confidence interval (CI)=7.9-18.1] for open procedures, 9 weeks (95% CI=1.4-16.6) for percutaneous, and 6 weeks (95% CI=4.3-7.7) for osteosynthesis alone ( P =0.1). Failure rates were 41%, 43%, and 36%, respectively. Overall, 2 and 5-year failure-free survival was 69.6% (95% CI=59.2-80.0) and 54.5% (95% CI=41.6-67.4), respectively. Risk factors associated with failure were age younger than 10 years [hazard ratios (HR)=2.9, 95% CI=1.4-5.8], cyst volume >55 cm 3 (HR=1.7, 95% CI=0.8-2.5), and fracture at diagnosis (HR=1.4, 95% CI=0.7-3.3).
CONCLUSIONS: As both open and percutaneous procedures along with osteosynthesis alone seem viable treatment options in this weight-bearing location, optimal treatment for proximal femoral ABCs remains unclear. The aim of the treatment was to achieve local cyst control while minimizing complications and ensuring that children can continue their normal activities as soon as possible. A personalized balance should be maintained between undertreatment, with potentially higher risks of pathologic fractures, prolonged periods of partial weight-bearing, or recurrences, versus overtreatment with large surgical procedures, and associated risks.
METHODS: Level IV, therapeutic study.
摘要：
背景：动脉瘤性骨囊肿（ABC）是罕见的良性囊性骨肿瘤，一般诊断为儿童和青少年。由于病理性骨折风险增加，股骨近端ABCs可能需要特定的治疗策略。由于很少有报告在ABC上发布，特别是对于这种本地化，缺乏关于最佳治疗的共识。我们提出了一项关于小儿股骨近端ABCs治疗的大型回顾性研究。
方法：纳入所有符合资格的股骨近端ABC患儿，来自11个三级肌肉骨骼肿瘤转诊中心（2000-2021）。患者人口统计学，诊断,治疗,并对并发症进行了评估。索引程序分为经皮/开放程序和单独的骨缝合术。主要结果是：直到完全负重和无故障生存的时间。失败定义为初次手术后的开放手术，>3个经皮手术，复发,和/或骨折。评估失败的危险因素。
结果：纳入了79例ABC患者[平均年龄，10.2(±SD4.0)y,n=56男性]。中位随访时间为5.1年（四分位距=2.5至8.8）。索引程序为经皮手术（n=22），开放程序（n=35），或单独的骨合成（n=22）。开放手术的中位负重时间为13周[95％置信区间（CI）=7.9-18.1]，经皮9周（95%CI=1.4-16.6），和6周（95％CI=4.3-7.7）单独骨合成（P=0.1）。故障率为41%，43%,36%,分别。总的来说,2年和5年无失败生存率分别为69.6％（95％CI=59.2-80.0）和54.5％（95％CI=41.6-67.4），分别。与失败相关的危险因素是年龄小于10岁[风险比（HR）=2.9，95％CI=1.4-5.8]，囊肿体积>55cm3（HR=1.7，95％CI=0.8-2.5），和骨折诊断（HR=1.4，95%CI=0.7-3.3）。
结论：由于开放和经皮手术以及单独的骨接合术在这个负重位置似乎是可行的治疗选择，股骨近端ABCs的最佳治疗仍不清楚.治疗的目的是实现局部囊肿控制，同时最大限度地减少并发症，并确保儿童能够尽快继续正常活动。在治疗不足之间应该保持个性化的平衡，病理性骨折的潜在风险更高，长时间的部分承重，或复发，与大型外科手术的过度治疗相比，和相关风险。
方法：四级，治疗性研究。
方法：纳入所有符合资格的股骨近端ABC患儿，来自11个三级肌肉骨骼肿瘤转诊中心（2000-2021）。患者人口统计学，诊断,治疗,并对并发症进行了评估。索引程序分为经皮/开放程序和单独的骨缝合术。主要结果是：直到完全负重和无故障生存的时间。失败定义为初次手术后的开放手术，>3个经皮手术，复发,和/或骨折。评估失败的危险因素。
结果：纳入了79例ABC患者[平均年龄，10.2(±SD4.0)y,n=56男性]。中位随访时间为5.1年（四分位距=2.5至8.8）。索引程序为经皮手术（n=22），开放程序（n=35），或单独的骨合成（n=22）。开放手术的中位负重时间为13周[95％置信区间（CI）=7.9-18.1]，经皮9周（95%CI=1.4-16.6），和6周（95％CI=4.3-7.7）单独骨合成（P=0.1）。故障率为41%，43%,36%,分别。总的来说,2年和5年无失败生存率分别为69.6％（95％CI=59.2-80.0）和54.5％（95％CI=41.6-67.4），分别。与失败相关的危险因素是年龄小于10岁[风险比（HR）=2.9，95％CI=1.4-5.8]，囊肿体积>55cm3（HR=1.7，95％CI=0.8-2.5），和骨折诊断（HR=1.4，95%CI=0.7-3.3）。
结论：由于开放和经皮手术以及单独的骨接合术在这个负重位置似乎是可行的治疗选择，股骨近端ABCs的最佳治疗仍不清楚.治疗的目的是实现局部囊肿控制，同时最大限度地减少并发症，并确保儿童能够尽快继续正常活动。在治疗不足之间应该保持个性化的平衡，病理性骨折的潜在风险更高，长时间的部分承重，或复发，与大型外科手术的过度治疗相比，和相关风险。
方法：四级，治疗性研究。
