目的:专业文献中描述了许多治疗青少年和动脉瘤性骨囊肿(ABC)的方法,并讨论了相关的愈合和复发率。由于目前尚无针对这些疾病的循证治疗标准,这篇系统的文献综述与荟萃分析的目的是检验不同的管理方法,评估相应的临床结果,在适当的情况下,制定有效的治疗建议。
方法:基于预先存在的搜索策略对OVIDMedline®进行的系统搜索返回了1333种出版物。确定了纳入和排除标准,并对相关全文进行了分析,167篇出版物被纳入描述性分析,163篇被纳入荟萃分析。为此,创建了不同的子组,根据囊肿的类型和治疗程序。然后分析这些亚组的治愈率,复发次数和并发症发生率。
结果:对于动脉瘤性骨囊肿,手术切除和多西环素注射均可带来优异的结局(98%愈合)和低复发率(分别为6%和11%.).刮治(91%愈合),包括其与自体松质骨移植(96%愈合)的组合,显示出非常好的治愈率,但复发率较高(22%和15%,resp.),然而,通过术前选择性动脉栓塞术得到了改善。必须对放疗(90%愈合)和注射酒精(92%愈合)进行严格的观察,因为它们的高并发症发生率(0.43/囊肿和0.42/囊肿,resp.).在青少年骨囊肿的管理中,刮治和松质骨移植等手术干预措施(87%愈合)远远优于非手术方法(51%愈合),此外,与单纯刮宫术(20%复发)相比,应用自体松质骨移植可降低复发率(3%复发).在亚组分析中,通过ESIN治疗被发现产生优异的结果(100%愈合),虽然病人的集体很小。
结论:治疗动脉瘤性骨囊肿的外科手术似乎是选择的方法,因此多西环素注射可能是一种替代方法。在治疗青少年骨囊肿时应首选手术方法。
OBJECTIVE: Numerous approaches to the management of juvenile and aneurysmal bone cysts (ABC) are described in the specialist literature together with discussion of the associated healing and recurrence rates. Since there is currently no evidence-based treatment standard for these conditions, the aim of this systematic literature
review with meta-analysis was to examine the different management approaches, evaluate the corresponding clinical outcomes and, as appropriate, to formulate a valid treatment recommendation.
METHODS: A systematic search on OVID Medline® based on a pre-existing search strategy returned 1333 publications. Having defined inclusion and exclusion criteria and analysis of the relevant full texts, 167 publications were included in the descriptive analysis and 163 in the meta-analysis. For this purpose, different subgroups were created, based on the type of cyst and the therapeutic procedure. Those subgroups were then analysed in relation to their healing rates, the number of recurrences and complication rates.
RESULTS: For aneurysmal bone cysts, both surgical removal and Doxycycline injection lead to excellent outcomes (98% healing) and low recurrence rates (6% and 11% resp.). Curettage (91% healing), including its combination with autologous cancellous bone graft (96% healing), showed very good healing rates but higher recurrence rates (22% and 15%, resp.), which were however improved by preoperative selective arterial embolization. A critical view must be taken of radiotherapy (90% healing) and the injection of alcohol (92% healing) because of their high complication rates (0.43/cyst and 0.42/cyst, resp.). In the management of juvenile bone cysts, surgical interventions like curettage and cancellous bone graft (87% healing) are far superior to non-surgical approaches (51% healing), furthermore, the application of autologous cancellous bone graft reduced the recurrence rate (3% recurrence) compared to curettage alone (20% recurrence). In subgroup analysis, treatment by ESIN was found to produce excellent outcomes (100% healing), though the patient collectives were small.
CONCLUSIONS: Surgical procedures to treat aneurysmal bone cysts appear to be the method of choice whereby Doxycycline injection may be an alternative. A surgical approach should be preferred in the treatment of juvenile bone cysts.