Abstract
PurposeThe primary aim of our study was to evaluate the comparative efficacy and safety profile of curettage and mixed bone grafting without instrument or with elastic intramedullary nailing in the treatment of humeral bone cyst in children.MethodsOur retrospective study included a total of 48 children harboring humeral bone cyst in our hospital from August 2012 to February 2019. The patients enrolled were divided into elastic nailing group with the application of elastic intramedullary nailing (n = 25) and control group without using instrument (n = 23) during the management of curettage and mixed bone grafting. The following medical outcomes of the two groups were monitored and recorded: the amount of intraoperative blood loss, operation time and postoperative full weight-bearing time, in addition to postoperative clinical effects after 1 year, the function and pain level of shoulder joint before and 1, 3, 6, 9, 12, and 16 months after operation. Follow-up radiographic outcomes were reviewed to observe bone healing, local recurrence and internal fixation loosening, and other postoperative complications.ResultsThe clinical curative effect of the elastic nailing group was higher than that of the control group 16 months after operation (96.00% > 73.91%, P < 0.05). The intraoperative blood loss and postoperative full weight-bearing time in the elastic nailing group were less than those in the control group (P < 0.05), but the operation time was statistically insignificant between the two groups (P > 0.05). Before operation, the shoulder joint function of the two groups was comparable (P > 0.05), while the function showed remarkably better outcome in the elastic nailing group than control group 1 to 16 months after operation (P < 0.05). Before operation, the pain level of the two groups was comparable (P > 0.05), while 1 to 16 months after operation, the pain level of the elastic nailing group was significantly lower than that of the control group (P < 0.05). Patients in both groups were followed up for 16 months. Mixed bone grafting fusion was indicated by imaging CT and X-ray during the follow-up period, with an average fusion time of 11.3 ± 1.2 months (range, 8–16 months). Three months after operation, there was 1 case of incomplete pathological fracture in the control group, while no related complications occurred in the elastic nailing group. Moreover, no tumor recurrence was observed in the two groups. The two groups were comparable in terms of the incidence of complications (P > 0.05).ConclusionChildren with humeral cyst treated with curettage and mixed bone grafting with the additional use of elastic intramedullary nailing exerted superior results to those without using instrument as there are beneficial outcomes and safety profile and no complications.
Highlights
Humeral bone cyst is a benign tumor-like lesion, affecting an increasing number of children and adolescents
The major challenge with these approaches is the lack of unified standard, and the effects of different treatment methods vary, which leads to negative effect on the quality of life of patients, as well as the prognosis
Regarding the fact that there are limited domestic studies on the efficacy of elastic intramedullary nailing combined with focal curettage and mixed bone grafting, our study attempts to explore the efficacy and safety of elastic intramedullary nailing during focal curettage and mixed bone grafting for the treatment of humeral cyst in children, in order to provide an effective way of treating the disease
Summary
Humeral bone cyst is a benign tumor-like lesion, affecting an increasing number of children and adolescents. This type of lesion originates from intramedullary and concealed, which shows expansive growth. The most used therapies include focal curettage and mixed bone grafting with or without additional use of elastic intramedullary nailing. Based on the studies of Yao and Ye [7] and Flont et al [8], the healing rate showed different effects with and without elastic intramedullary nailing during the treatment of focal curettage and mixed bone grafting. Regarding the fact that there are limited domestic studies on the efficacy of elastic intramedullary nailing combined with focal curettage and mixed bone grafting, our study attempts to explore the efficacy and safety of elastic intramedullary nailing during focal curettage and mixed bone grafting for the treatment of humeral cyst in children, in order to provide an effective way of treating the disease
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