PubMed2004
PURPOSE OF THE STUDY: The aim of the study was to evaluate the long-term results of using the bioactive, glass-ceramic material BAS-0 for bone tissue replacement after removal of juvenile bone cysts by curettage. MATERIAL: Between 1990 and 2000, BAS-0 material was used to fill the cavity after removal of a juvenile bone cyst in 21 patients, 15 males and 6 females, with an average age of 15 years (range 4 to 44 years). Surgical treatment was indicated only in juvenile bone cysts meeting the following criteria: 1) subjective complaints, i. e., pain at activity; 2) X-ray findings of either a) thinning cortical layer with a potential for pathological fracture, particularly in the proximal femur, b) recurrent pathological fractures without apparent healing of the cyst or c) increase in cyst size by 25% within 6 months. In all patients, the diagnosis of a juvenile bone cyst was confirmed by histological examination. Cyst localization was as follows: eight in the humerus, eight in the femur, two in the fibula and one in the ulna, iliac bone and tibia each. METHODS: After careful curettage of a soft tissue lining from the inner surface of the cystic cavity, the space was filled completely with 2- to 4-mm BAS-0 granules in 15 patients; in the rest granules were applied in a mixture with cancellous bone graft, which was either autologous or allogenic. The former was implanted in one patient, the latter, taken from either the mother or father, was used in four and one patients, respectively. All patients were clinically and radiologically examined during the follow-up period of 3 to 12 years, with an average of 7 years. The clinical evaluation was based on subjective complaints, and on the state of soft tissues in the region of lesion, range of motion in the adjacent joints and the loading capacity of the limb treated. Radiological evaluation was based on standard X-ray images assessed according to the classification system of Neer. RESULTS: The clinical examination showed that 10 patients were free from subjective complaints, one patient had rest pain, three patients experienced pain when using the limb, four patients reported mild and intermittent pain, two patients were in pain when the whether changed and one patient complained of pain during pregnancy. Objectively, no inflammatory changes of soft tissues were found. Both passive and active motion of the adjacent joints was possible in the full range and the treated limb retained its complete function in all patients. X-ray examination showed excellent results, i. e., no residuum or cysts recurrence, in 16 patients. A residual lesion was present in one patient and cyst recurrence was recorded in four patients. DISCUSSION: The currently used methods of treatment include corticoid instillation in the cyst, injection of autologous bone marrow, multiple drilling and drainage of the cyst and removal of the cyst with subsequent filling of the cavity with bone graft. In our patients, the bioactive, glass-ceramic material BAS-0 was used to replace either autogenous or allogenic bone grafts. Complete healing of the cyst was achieved in 76% of our patients, which is the result comparable with the literature data. CONCLUSIONS: Although the therapy of juvenile bone cysts has changed from extensive surgical procedures to less invasive techniques, the curettage of a cyst with subsequent filling of the residual cavity still remains the method of choice in selected patients. Instead of autogenous cancellous bone grafts or allogenic grafts predominantly used for this procedure, the bioactive, glass-ceramic material BAS-0 can be recommended, particularly when the cavity to be filled is located in the metaphysis of a long bone, i. e., in the region subject to great compression.