Abstract：
The aim of this study is to evaluate the surgical treatment with the best healing rate for patients with proximal femoral unicameral bone cysts (UBCs) after initial surgery, and to determine which procedure has the lowest adverse event burden during follow-up.
This multicentre retrospective study was conducted in 20 tertiary paediatric hospitals in France, Belgium, and Switzerland, and included patients aged < 16 years admitted for UBC treatment in the proximal femur from January 1995 to December 2017. UBCs were divided into seven groups based on the index treatment, which included elastic stable intramedullary nail (ESIN) insertion with or without percutaneous injection or grafting, percutaneous injection alone, curettage and grafting alone, and insertion of other orthopaedic hardware with or without curettage.
A total of 201 patients were included in the study. The mean age at diagnosis was 8.7 years (SD 3.9); 77% (n = 156) were male. The mean follow-up was 9.4 years (SD 3.9). ESIN insertion without complementary procedure had a 67% UBC healing rate after the first operation (vs 30% with percutaneous injection alone (p = 0.027), 43% with curettage and grafting (p = 0.064), and 21% with insertion of other hardware combined with curettage (p < 0.001) or 36% alone (p = 0.014)). ESIN insertion with percutaneous injection presented a 79% healing rate, higher than percutaneous injection alone (p = 0.017), curettage and grafting (p = 0.028), and insertion of other hardware combined with curettage (p < 0.001) or alone (p = 0.014). Patients who underwent ESIN insertion with curettage had a 53% healing rate, higher than insertion of other hardware combined with curettage (p = 0.009). The overall rate of postoperative complications was 25% and did not differ between groups (p = 0.228). A total of 32 limb length discrepancies were identified.
ESIN insertion, either alone or combined with percutaneous injection or curettage and grafting, may offer higher healing rates than other operative procedures. Limb length discrepancy remains a major concern, and might be partly explained by the cyst\'s location and the consequence of surgery. Therefore, providing information about this risk is crucial.
This multicentre retrospective study was conducted in 20 tertiary paediatric hospitals in France, Belgium, and Switzerland, and included patients aged < 16 years admitted for UBC treatment in the proximal femur from January 1995 to December 2017. UBCs were divided into seven groups based on the index treatment, which included elastic stable intramedullary nail (ESIN) insertion with or without percutaneous injection or grafting, percutaneous injection alone, curettage and grafting alone, and insertion of other orthopaedic hardware with or without curettage.
A total of 201 patients were included in the study. The mean age at diagnosis was 8.7 years (SD 3.9); 77% (n = 156) were male. The mean follow-up was 9.4 years (SD 3.9). ESIN insertion without complementary procedure had a 67% UBC healing rate after the first operation (vs 30% with percutaneous injection alone (p = 0.027), 43% with curettage and grafting (p = 0.064), and 21% with insertion of other hardware combined with curettage (p < 0.001) or 36% alone (p = 0.014)). ESIN insertion with percutaneous injection presented a 79% healing rate, higher than percutaneous injection alone (p = 0.017), curettage and grafting (p = 0.028), and insertion of other hardware combined with curettage (p < 0.001) or alone (p = 0.014). Patients who underwent ESIN insertion with curettage had a 53% healing rate, higher than insertion of other hardware combined with curettage (p = 0.009). The overall rate of postoperative complications was 25% and did not differ between groups (p = 0.228). A total of 32 limb length discrepancies were identified.
ESIN insertion, either alone or combined with percutaneous injection or curettage and grafting, may offer higher healing rates than other operative procedures. Limb length discrepancy remains a major concern, and might be partly explained by the cyst\'s location and the consequence of surgery. Therefore, providing information about this risk is crucial.
摘要：
■这项研究的目的是评估初次手术后股骨近端单房骨囊肿（UBC）患者的最佳治愈率的手术治疗，并确定在随访期间哪种程序具有最低的不良事件负担。
■这项多中心回顾性研究是在法国20家三级儿科医院进行的，比利时,瑞士,纳入1995年1月至2017年12月在股骨近端接受UBC治疗的年龄<16岁患者.根据指数治疗将UBC分为7组，其中包括弹性稳定髓内钉（ESIN）插入有或没有经皮注射或移植，单独经皮注射，单独刮宫和嫁接，并在有或没有刮宫的情况下插入其他骨科硬件。
■总共201名患者被纳入研究。诊断时的平均年龄为8.7岁（SD3.9）；77％（n=156）为男性。平均随访时间为9.4年（SD3.9）。无补充手术的ESIN插入在第一次手术后有67%的UBC愈合率(与单纯经皮注射的30%相比(p=0.027),43%采用刮除和嫁接(p=0.064)，和21％与插入其他硬件结合刮治（p<0.001）或36％单独（p=0.014））。经皮注射插入ESIN的治愈率为79%，高于单独经皮注射（p=0.017），刮治和嫁接（p=0.028），并插入其他硬件结合刮治（p<0.001）或单独（p=0.014）。进行ESIN插入刮宫的患者治愈率为53％，高于插入其他硬件结合刮宫术(p=0.009)。术后并发症的总发生率为25％，组间没有差异（p=0.228）。确定了总共32个肢体长度差异。
■ESIN插入，单独或联合经皮注射或刮治和移植，可能提供比其他手术更高的治愈率。肢体长度差异仍然是一个主要问题，部分原因可能是囊肿的位置和手术的后果。因此,提供有关此风险的信息至关重要。
■这项多中心回顾性研究是在法国20家三级儿科医院进行的，比利时,瑞士,纳入1995年1月至2017年12月在股骨近端接受UBC治疗的年龄<16岁患者.根据指数治疗将UBC分为7组，其中包括弹性稳定髓内钉（ESIN）插入有或没有经皮注射或移植，单独经皮注射，单独刮宫和嫁接，并在有或没有刮宫的情况下插入其他骨科硬件。
■总共201名患者被纳入研究。诊断时的平均年龄为8.7岁（SD3.9）；77％（n=156）为男性。平均随访时间为9.4年（SD3.9）。无补充手术的ESIN插入在第一次手术后有67%的UBC愈合率(与单纯经皮注射的30%相比(p=0.027),43%采用刮除和嫁接(p=0.064)，和21％与插入其他硬件结合刮治（p<0.001）或36％单独（p=0.014））。经皮注射插入ESIN的治愈率为79%，高于单独经皮注射（p=0.017），刮治和嫁接（p=0.028），并插入其他硬件结合刮治（p<0.001）或单独（p=0.014）。进行ESIN插入刮宫的患者治愈率为53％，高于插入其他硬件结合刮宫术(p=0.009)。术后并发症的总发生率为25％，组间没有差异（p=0.228）。确定了总共32个肢体长度差异。
■ESIN插入，单独或联合经皮注射或刮治和移植，可能提供比其他手术更高的治愈率。肢体长度差异仍然是一个主要问题，部分原因可能是囊肿的位置和手术的后果。因此,提供有关此风险的信息至关重要。
