Summary
In a retrospective study of 155 patients with different types of benign lesions of bone, the rate of recurrence following simple currettage was analysed in relation to sex, age, histological type, the location and the size of the tumour, and the type of bone graft used at operation. All patients were followed for a minimum of 2 years, 131 (85%) for 5 years and 101 (65%) for 10 years or more.
The overall rate of recurrence was 23%. All recurrences except one were within 6 years of the initial operation, 80% within 3 years and 49% within 1 year. The overall rate of cure using curettage as the sole treatment, although repeated several times in some cases, was 95%. Only 5% of the patients required more extensive surgery, such as local resection (6 cases) and amputation (1 case), to control the tumour.
The histological type and the sex of the patient proved to be the only factors statistically related to recurrence, although with solitary cysts the age of the patient was also relevant. Significantly higher recurrence occurred with giant cell tumours and aneurysmal bone cysts, in females, and with solitary cysts in patients under 9 years of age.
This study of histologically different benign lesions treated in a uniform manner at a single centre shows that the rate of recurrence is strongly related to the type of tumour. The choice of treatment in patients with benign lesions of bone should be dictated by the histological appearance of the lesion. More extensive surgical procedures may not be necessary but other measures may be used in addition to curettage.
Résumé
Dans une étude rétrospective de 115 sujets atteints de diverses tumeurs osseuses bénignes, on a analysé la fréquence des récidives après simple curetage, en relation avec l'âge, le sexe, le type histologique de la tumeur, sa localisation et sa taille, ainsi qu'avec le type de greffe osseuse utilisée lors de l'opération. Tous les malades ont été suivis au moins 2 ans, 131 (85%) 5 ans et 101 (65%) 10 ans ou plus.
Le pourcentage global de récidive est de 23%. Toutes sauf une sont survenues dans les six ans qui suivent l'intervention, 80% dans les 3 ans et 49% dans la première année. Le pourcentage global de guérison obtenu par le seul curetage, répété plusieurs fois dans quelques cas, est de 95%. Une chirurgie plus extensive, telle que résection (6 cas) et amputation (1 cas), n'a été nécessaire pour obtenir le contrôle des lésions que chez 5% des malades.
Le type histologique et le sexe du patient sont les seuls facteurs statistiquement en rapport avec la récidive, bien que dans les kystes solitaires l'âge du malade soit également corrélé. Un fréquence significativement plus élevée s'observe chez les sujets de sexe féminin en cas de tumeurs à cellules géantes et de kystes anévrysmaux, ainsi que chez les enfants de moins de 8 ans en cas de kyste solitaire.
Cette étude de tumeurs bénignes de divers types histologiques, traitées dans un même centre de manière uniforme, montre que la fréquencë des récidives est en rapport étroit avec le type de la tumeur. Le choix du traitement chez des sujets présentant des lésions osseuses bénignes doit dépendre des caractéristiques histologiques de la tumeur. Des techniques chirurgicales extensives ne sont pas nécessaires mais d'autres procédés thérapeutiques peuvent être associés au curetage.
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Kreicbergs, A., Lönnqvist, P.A. & Nilsson, B. Curettage of benign lesions of bone. International Orthopaedics 8, 287–294 (1985). https://doi.org/10.1007/BF00266874
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DOI: https://doi.org/10.1007/BF00266874