HALUK ÖZCANLI, Ahmet T. AYDIN, A. Bora YETER, F. Feyyaz AKYILDIZ, E. İnanç GÜRER

Humerus üst uç yerleşimli anevrizmal kemik kistilerinin tedavisinde yeni bir yöntem: Kortikal çöktürme

Amaç: Bu çalışmada, humerus proksimal metafizine santral olarak yerleşmiş, geniş destrüksiyon yapmış anevrizmal kemik kistleri için geliştirdiğimiz yeni bir tekniğin sonuçları değerlendirildi. Çalışma planı: Humerus proksimal metafizinde santral olarak gelişen ve geniş destrüksiyona neden olan, klinik ve radyografik olarak anevrizmal kemik kisti tanısı konan yedi hasta (5 erkek, 2 kız; ort. yaş 12.8; dağılım 9-15) kortikal çöktürme ve fibuladan alınan masif otogreft ile tedavi edildi. Tüm olgularda Capanna ve ark.nın sınıflandırmasına göre tip II, Campanacci ve ark.nın sınıflandırmasına göre aktif tümör vardı. Bir olgu takipten çıktığı için çalışma dışı bırakıldı. Hastaların ortalama takip süresi 49 ay (dağılım 12-105 ay) idi. Sonuçlar: Ameliyat sonrası erken dönemde hiçbir olguda komplikasyon görülmedi. Radyografik değerlendirmede iki olguda kısmi nüks saptandı; bu olgulardan birine, ağrı yakınması nedeniyle ameliyat sonrası ikinci yılda küretaj ve greftleme uygulandı. Olgularda deformite izlenmedi. Sadece bir olguda 0.5 cm’lik kısalık saptandı. Ameliyattan yaklaşık bir yıl sonra metafizer bölgenin anatomik görünümde yeniden şekillendiği gözlendi. Tüm olgularda omuz eklem fonksiyonu normale yakın bulundu. Çıkarımlar: Uyguladığımız teknikte, kortikal çöktürme ile greft ihtiyacı azalmakta, fibular greft de yapısal destek oluşturarak deformite oluşumunu engellemektedir.

Anahtar Kelimeler:

Küretaj, Humerus, Ameliyat sonrası dönem, Tekrarlama, Kemik nakli, Tedavi sonucu, Kemik kistleri, anevrizmal

A new technique for aneurysmal bone cysts of the proximal humerus: Cortical collapsing

Objectives: We evaluated the results of a new technique developed for aneurysmal bone cysts centrally located in the proximal humeral metaphysis leading to widespread destruction. Methods: The study included seven patients (5 boys, 2 girls; mean age 12.8 years; range 9 to 15 years) who were treated with cortical collapsing and massive fibular autograft for centrally located aneurysmal bone cysts in the proximal humeral metaphysis leading to widespread destruction. All the patients had type II and active tumors according to the criteria of Capanna et al. and Campanacci et al., respectively. Final evaluations included six patients because one patient was lost to follow-up. The mean follow- up period was 49 months (range 12 to 105 months). Results: No complications were seen in the early postoperative period. Radiographic examination showed partial recurrence in two patients; of whom, one patient underwent curettage and bone grafting in the postoperative second year because of pain and discomfort. No deformity was observed. One patient developed shortening of 0.5 cm. Radiographically, all the patients exhibited metaphyseal remodelling one year after surgery. Function of the shoulder joint was near-normal in all the patients. Conclusion: In this technique, cortical collapsing reduces the amount of bone graft used, and massive fibular strut grafting provides structural support to prevent deformities.

Keywords:

Curettage, Humerus, Postoperative Period, Recurrence, Bone Transplantation, Treatment Outcome, Bone Cysts, Aneurysmal,

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