대한골관절종양학회지 (The Journal of the Korean bone and joint tumor society)

  • 제17권2호
  • /
  • Pages.58-64
  • /
  • 2011
  • /
  • 1226-4962(pISSN)
  • /
  • 2233-9841(eISSN)
대한근골격종양학회 (The Korean Musculoskeletal Tumor Society)
권호 표지
DOI QR코드

DOI QR Code

단순 골낭종에서 발생한 병적 골절

Pathologic Fracture of Unicameral Bone Cyst

  • 주석규 (인제대학교 의과대학 일산백병원 정형외과학교실) ;
  • 이희두 (인제대학교 의과대학 일산백병원 정형외과학교실) ;
  • 오형근 (인제대학교 의과대학 일산백병원 정형외과학교실)
  • Choo, Suk-Kyu (Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Hee-Du (Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Oh, Hyoung-Keun (Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University College of Medicine)
  • 투고 : 2011.08.08
  • 심사 : 2011.11.30
  • 발행 : 2011.12.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 단순 골낭종의 병적 골절 환자를 대상으로 단순 골낭종의 관해에 미치는 예후 인자에 대하여 알아보고자 하였다. 대상 및 방법: 2001년부터 2010년까지 본원에 내원한 단순 골낭종을 동반한 병적 골절 환자 13명을 대상으로 하였으며, 평균 추시 기간은 26개월(3-90개월)이었다. 성별은 남자 11명, 여자 2명이었으며, 평균 나이는 10.2세(6-16세)였다. 발생 부위는 근위 상완골 9명, 상완골 간부 2명, 근위 대퇴골 1명, 근위 경골 1명이었다. 단순 골낭종의 병적 골절에 대하여 보존적 치료로 단순 석고 고정 후 골절 유합을 시도하였으며, 1명은 일차적으로 골이식 및 관헐적 정복술과 내고정술을 시행하였다. 5명의 환자에서 치료 경과 중 스테로이드 주사를 시행하였으며, 2명에서 골이식을 시행하였다. 병적 골절 치료 중의 단순 골낭종의 변화 및 연령, 낭종의 크기, 성장판 침범 정도에 따른 단순 골낭종의 예후 인자에 대해 분석하였다. 결과: 병적 골절 후 전례에서 평균 8.2개월에 골유합을 얻었으며, 13명의 환자 중 4명(31%)에서 골낭종의 완전 관해를 보였다. 발병 나이에 따른 단순 골낭종 관해의 통계적 차이는 없었지만(p=0.42), 낭종의 크기가 클수록, 성장판에 근접한 경우 관해를 얻기가 어려웠다(p=0.05, p=0.03). 결론: 단순 골낭종의 병적 골절에서 관해가 이루어질 수 있으나, 낭종의 크기가 크거나 성장판에 근접한 경우에는 좀 더 적극적인 치료가 필요할 것으로 보인다.

Purpose: The purpose of this study is to observe unicameral bone cyst (UBC) outcome after the fracture has healed and if there is any identifiable prognostic factors. Materials and Methods: 13 UBC patients with pathologic fracture from 2001 to 2010 were reviewed. The mean follow up were 26 months (3-90 months). There were 11 male and 2 female patients and the mean age of the patients were 10.2 years old (6-16 years). 9 involved proximal humerusand 2 involved humerus shaft and 1 involved proximal femur and 1 involved proximal tibia. The treatment of UBC fracture was conservative cast application to heal the fracture initially, and 1 patient was treated with primary auto bone graft and open reduction with internal fixation. 5 patients were treated with steroid injection during follow up period and 2 patients with auto bone graft. We analyzed the change of UBC during pathologic fracture healing period and prognostic factor about age, the size of UBC, the involvement of physis. Results: The mean duration of the fracture healing was 8.2 months. Complete healing were occurred at 4 patients (31%). No statiscal difference was checked with age about UBC healing (p=0.42). But, more larger size about UBC and more closer to physis, the healing was difficult (p=0.05, p=0.03). Conclusion: While pathologic fracture of UBC was possibly healed, active treatment should be applied especially those cysts that involvescloser area of the physis or large size.

키워드

참고문헌

  1. Virchow R. Uber die Bildung von Knochenzysten. Berlin: Sitzungb dAkad d Wissensch; 1876. 369.
  2. Campanacci M, Capanna R, Picci P. Unicameral and aneurismal bone cysts. Clin Orthop. 1986;204:25-36.
  3. Maski C, Susumu M, Satoru A, et al. The aetiology and treatment of simple bone cysts. Rhisho. Seiko. Geka. J Bone Joint Surg. 1983;65B:633-7.
  4. Cohen J. Etiology of simple bone cyst. J Bone Joint Surg. 1970;52A:1493-7.
  5. Cohen J. Simple bone cysts. Studies of cyst fluid in six cases with a theory of pathogenesis. J Bone Joint Surg. 1960;42A:609-16.
  6. Neer CS, Francis KC, Johnston AD, Kiernan HA Jr. Current concepts on the treatment of solitary unicameral bone cyst. Clin Orthop Relat Res. 1973;97:40-51. https://doi.org/10.1097/00003086-197311000-00008
  7. McKay DW, Nason SS. Treatment of unicameral bone cysts bysubtotal resection without grafts. J Bone Joint Surg Am. 1977;59:515-9. https://doi.org/10.2106/00004623-197759040-00017
  8. Killian JT, Wilkinson L, White S, Brassard M. Treatment of unicameral bone cyst with demineralized bone matrix. J Pediatr Orthop. 1998;18:621-4. https://doi.org/10.1097/00004694-199809000-00013
  9. Lokiec F, Wientroub S. Simple bone cyst: etiology, classification, pathology, and treatment modalities. J Pediatr Orthop B. 1998;7:262-73. https://doi.org/10.1097/01202412-199810000-00004
  10. Hahn SB, Kim NH, Park BM, Jeon CH. Comparison between treatment methods of simple bone cyst. J Korean Orthop Assoc. 1990;25:941-9.
  11. Neer CS 2nd, Francis KC, Marcove RC, Terz J, Carbonara PN. Tretment of unicameral bone cyst. A follow-up study of one hundred seventy-five cases. J Bone Joint Surg Am. 1986;48:731-45.
  12. Baker DM. Benign unicameral bone cyst. A study of forty-five cases with long term follow up. Clin Orthop Relat Res. 1970;71:140-51.
  13. Wilkins RM. Unicameral bone cysts. J Am Acad Orthop Surg. 2000;8:217-24. https://doi.org/10.5435/00124635-200007000-00002
  14. Makley JT, Joyce MJ. Unicameral bone cyst (simple bone cyst). Orthop Clin North Am. 1989;20:407-15.
  15. Ahn JI, Park JS. Pathological fractures secondary to unicameral bone cysts. Int Orthop. 1994;18:20-2.
  16. Capannachia R, Dal Monte A, Gitelis S, Campanacci M. The natural history of unicameral bone cyst after steroid injuection. Clin Orthop. 1982;166:204-11.
  17. Campanacci M, Capanna R, Picci P. Unicameral and aneurismal bone cysts. Clin Orthop Relat Res. 1986;204:25-36.
  18. Oppenheim W, Galleno H. Operative treatment versus steroid injection in the management of unicameral bone cysts. J Pediatr Orthop. 1984;4:1-7. https://doi.org/10.1097/01241398-198401000-00001
  19. Moed BR, LaMont RL. Unicameral bone cyst complicated by growth retardation. J Bone Joint Surg Am. 1982;64:1379-81. https://doi.org/10.2106/00004623-198264090-00018
  20. Hecht AC, Gebhardt MC. Diagnosis and treatment of unicameral and aneurysmal bone cysts in children. Curr Opin Pediatr. 1998;10:87-94. https://doi.org/10.1097/00008480-199802000-00018
  21. Capanna R, Campanacci DA, Manfrini M. Unicameral and aneurysmal bone cysts. Orthop Clin North Am. 1996;27:605-14.