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Abstract：
Simple bone cysts (SBCs) and intraosseous lipoma (IOL) of the calcaneus are rare tumor entities that are primarily diagnosed due to unspecific heel pain, incidental findings, or rarely due to pathological fractures. Compared to traditional open tumor resections, endoscopic resection of these benign tumors aims to minimize surgical morbidity and maximize surgical efficiency without compromising safety. Grafting is regularly performed to reduce the risk of recurrence and stimulate osseous consolidation of the lytic lesion. As the incidence is low and treatment strategies are heterogeneous, there is no clear consensus for the treatment of simple cysts or intraosseous lipomas of the calcaneus. The objectives of this study are (a) to present medium to long-term results after endoscopic resection and grafting with allogenic cancellous bone or bioresorbable hydroxyapatite and calcium sulfate cement, and (b) to add further evidence to the discussion of whether calcaneal SBC and IOL are the same entity at different developmental stages. Between 2012 and 2019, a total of 25 benign bone tumors consisting of 17 SBCs and 8 IOLs were treated by A.T. with endoscopic resection and grafting, comprising the largest cohort to date. For grafting, 12 patients received allogenic cancellous bone (group A) and 13 patients received injectable bone substitute (group B). Pre- and postoperative imaging using plain X-rays and MRI was retrospectively analyzed with a mean follow-up time of 24.5 months to assess tumor size, osseous consolidation (modified Neer classification), and tumor recurrence. A retrospective chart analysis focusing on adverse intra- and perioperative events and other complications associated with the surgical procedure was performed using the modified Clavien-Dindo classification (CD1-3). A total of 12/13 cases with allogenic bone grafting showed a Neer Type 1 osseous healing of the tumorous lesion after endoscopic resection, whereas only 5/11 cases with injectable bone substitute showed sufficient healing (types 1 and 2). There were three recurrent cysts (Neer 4) and two persistent cysts (Neer 3) after using injectable bone substitute. Two CD1 complications were observed in group A (prolonged wound drainage, sural neuritis) and eight complications were observed in group B (6× CD1, 2× CD3). At least two IOLs diagnosed preoperatively using MRI were ultimately identified as SBCs upon histopathologic examination. Allogenic cancellous bone grafting after endoscopic resection of calcaneal SBC or IOL showed a very low rate of complications and no tumor recurrence in our series. On the other hand, depending on the material used, injectable bone substitute showed a high rate of \"white-out\" (excessive drainage), resulting in multiple complications such as prolonged wound healing, insufficient permanent defect filling, recurrence, and revision surgery. Over time, calcaneal SBC may transform into IOL, exhibiting distinct features of both entities simultaneously during ossoscopy and histopathological analysis.
摘要：
跟骨的单纯性骨囊肿（SBC）和骨内脂肪瘤（IOL）是罕见的肿瘤实体，主要是由于非特异性足跟痛而诊断。偶然发现，或很少由于病理性骨折。与传统的开放性肿瘤切除术相比，这些良性肿瘤的内镜切除术旨在在不影响安全性的前提下最大限度地降低手术发病率和提高手术效率.定期进行移植以降低复发的风险并刺激溶解性病变的骨性巩固。由于发病率低，治疗策略不同，对于跟骨单纯囊肿或骨内脂肪瘤的治疗尚无明确共识。这项研究的目的是（a）在内窥镜切除和同种异体松质骨或生物可吸收的羟基磷灰石和硫酸钙水泥移植后呈现中长期结果，和（b）为讨论跟骨SBC和IOL在不同发育阶段是否是同一实体增加进一步的证据。在2012年至2019年之间，通过内窥镜切除和移植的A.T.治疗了25个良性骨肿瘤，其中包括17个SBC和8个IOL。包括迄今为止最大的队列。为了嫁接，12例患者接受同种异体松质骨（A组），13例患者接受可注射骨替代物（B组）。使用X线平片和MRI进行术前和术后成像回顾性分析，平均随访时间为24.5个月，以评估肿瘤大小。骨固结(修正的Neer分类)，和肿瘤复发。使用改良的Clavien-Dindo分类（CD1-3）进行了回顾性图表分析，重点分析了不良的围手术期和围手术期事件以及与外科手术相关的其他并发症。共12/13例同种异体植骨，经内镜切除肿瘤病灶Neer1型骨性愈合，而只有5/11例具有可注射骨替代物的病例显示出足够的愈合（1型和2型）。使用可注射骨替代物后，有三个复发性囊肿（Neer4）和两个持续性囊肿（Neer3）。A组观察到两种CD1并发症（伤口引流时间延长，腓肠神经炎）和B组8种并发症（6×CD1，2×CD3）。术前使用MRI诊断的至少两个IOL最终在组织病理学检查后被鉴定为SBC。跟骨SBC或IOL内窥镜切除后的同种异体松质骨移植显示，在我们的研究中，并发症发生率非常低，没有肿瘤复发。另一方面,根据使用的材料，可注射骨替代物显示出很高的“白化”率（过度引流），导致多种并发症，如伤口愈合时间延长，永久性缺陷填充不足，复发,和翻修手术。随着时间的推移,跟骨SBC可能转变为IOL，在骨镜检查和组织病理学分析中同时表现出两种实体的不同特征。
