背景:跟骨中的孤立性骨囊肿(跟骨囊肿)通常无症状。病理性骨折很少见,很少有关于其风险评估的报告。因此,手术干预的指征仍有争议,有必要进一步探讨跟骨囊肿的症状性囊肿和病理性骨折的治疗方法。
方法:回顾性分析21例跟骨骨囊肿患者(男16例,女5例)的临床资料。平均年龄为13.3岁(范围,7-23)年。临床数据,比如关于症状,放射学发现,病理结果和结果,被调查,并研究了症状性囊肿的发病机制。
结果:有13个囊肿有症状,偶然发现了八个。计算机断层扫描显示12例无骨折,八个微骨折和一个完整骨折。为建立囊肿大小和症状以及囊肿大小与病理性骨折(微骨折和完全骨折)之间的关联而计算的接收器操作特征曲线的曲线下面积分别为0.78和0.71。有症状的囊肿和病理性骨折与囊肿比例(囊肿大小/跟骨≥0.20)有关。在磁共振成像(MRI)上,21例患者中有11例(52%)出现液体水平.在手术的时候,从21个囊肿中的15个(71%)抽吸出血的血液.
结论:骨科医生应注意囊肿比例与临床症状和病理性骨折有关。MRI和总体发现显示囊性液体出血。跟骨囊肿,可能会发生反复的微骨折和自发愈合。
BACKGROUND: Solitary bone cysts in the calcaneus (calcaneal bone cysts) are often asymptomatic. Pathological fractures are rare, and few
reports are available concerning its risk assessment. Therefore, the indication for operative interventions remains debatable, and further discussion on the treatment of symptomatic cysts and pathological fractures in calcaneal bone cysts is necessary.
METHODS: Clinical data of 21 patients with calcaneal bone cysts (16 men and five women) was retrospectively reviewed. The average age was 13.3 (range, 7-23) years. Clinical data, such as concerning symptoms, radiological findings, pathological findings and outcomes, were investigated, and the pathogenesis of symptomatic cysts was studied.
RESULTS: Thirteen cysts were symptomatic, and eight were incidentally discovered. Computed tomography revealed no fracture in 12 cases, microfracture in eight and complete fracture in one. The areas under the curves of the receiver operating characteristic curves calculated to establish an association between cyst size and symptoms and cyst size and pathological fractures (microfracture and complete fracture) were 0.78 and 0.71, respectively. Symptomatic cysts and pathological fractures were associated with the cyst ratio (cyst size/calcaneus ≥ 0.20). On magnetic resonance imaging (MRI), fluid levels were observed in 11 of 21 (52%) patients. At the time of surgery, blood from the haemorrhage was aspirated from 15 of 21 (71%) cysts.
CONCLUSIONS: Orthopaedic surgeons should be aware that the cyst ratio is associated with clinical symptoms and pathological fractures. MRI and gross findings revealed haemorrhage in the cystic fluid. In calcaneal bone cysts, repeated microfractures and spontaneous healing might occur.