Simple Bone Cyst Management: Percutaneous Steroid Injection Versus Curettage With Hydroxiapatite

ACHMAD FAUZI KAMAL* -  Department of Orthophaedic and Traumatology, Cipto Mangunkusumo National Central Hospital/Faculty of Medicine University of Indonesia, Indonesia
RIZA APRIZAL -  Department of Orthophaedic and Traumatology, Cipto Mangunkusumo National Central Hospital/Faculty of Medicine University of Indonesia, Indonesia
YOGI PRABOWO -  Department of Orthophaedic and Traumatology, Cipto Mangunkusumo National Central Hospital/Faculty of Medicine University of Indonesia, Indonesia

DOI : 10.33371/ijoc.v11i2.504

ABSTRACT

The main goals of the therapy of simple bone cyst (SBC) are to get the bone healing, prevent pathological fractures, and management of pain symptom. There are various methods of the SBC treatments, however they still remain controversial because of their healing rate and invasiveness of surgery. A total of 10 SBC patients were divided into two groups namely curretage with hydroxyapatite (HA) and decompression and percutaneous steroid injection (PSI). PSI was performed three times at intervals of each month. The mean followup of 12-26 months. Evaluation of functional outcome by Musculoskeletal Tumour Society (MSTS) score and supported with radiologically based on Chang criteria. There were 5 patients (proximal femur 2; proximal humerus 2, radius 1) performed curretage with HA therapy. Remaining 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1) were performed PSI therapy. PSI group had better MSTS score, particulary at month 3 (55%) and month 6 (84%) than curettage with HA therapy (47% and 69.3%). Complete bone healing was found in both group at month 12 follow up, however solid union occurred faster in PSI group. PSI tends to have faster and better functional outcome than curettage and HA. Curettage with HA and PSI have similar complete bone healing at month 12 follow up.

 

ABSTRAK

Target utama penalaksanaan simple bone cyst (SBC) adalah mencapat penyembuhan tulang yang sempurna, mencegah fraktur patologis dan mengatasi gejala nyeri. Ada beberapa metode penatalaksanaan SBC, namun demikian masih menjadi perdebatan dikarenakan perbedaan angka penyembuhannya dan jenis pembedahan yang invsif. Sepuluh pasien yang didiagnosis SBC dikelompokkan menjadi kelompok yang mendapat tindakan curretage dan pengisian defek dengan hydroxyapatite (HA) dan kelompok dekompresi dan percutaneous steroid injection (PSI). Prosedur PSIdilakukan sebanyak 3x dengan interval waktu satu bulan. Follow up dilakukan selama 12 – 26 bulan. Evaluasi luaran fungsional menggunakan Musculoskeletal Tumour Society (MSTS) score dan secara radiologi sesuai criteria Chang. Terdapat 5 pasien (2 femur proksimal, 2 humerus proksimal, dan 1 radius) yang dilakukan prosedur curretage dan pengisian defek dengan HA. Lima pasien sisanya ( 3 fenur proximal, 1 humerus proximal dan 1 calcaneus) dilakukan prosedur PSI. Luaran fungsional Kelompok PSI memiliki MSTS score yang lebih baik, khususnya pada bulan ke- 3 (55%) dan bulan ke-6 (84%) daripada kelompok curettage dengan HA (47% dan 69.3%). Penyembulan tulang sempurna menunjukkan hasil yang sama pada evaluasi bulan ke-12, tetapi solid union didapatkan lebih cepat pada kelompok PSI. Kelompok PSI memiliki kecenderungan solid union dan luaran fungsional yang lebih cepat daripada kelompok curettage dengan HA. Kedua kelompok mencapai penyembuhan sempurna pada bulan ke-12 follow up

Keywords
Simple bone cyst; steroid injection; curretage; hydroxyapatite
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Article Info
Submitted: 2017-10-11
Published: 2017-10-11
Section: Research Articles
Article Statistics: 181 104