Bone cyst – a cavity in a bone tissue. Arises owing to violations of local blood circulation and activation of the certain enzymes destroying organic substance of a bone. Treats opukholepodobny diseases. Develops at children's and youthful age more often, usually affects long tubular bones. At initial stages proceeds asymptomatically or is followed by insignificant pains. It becomes frequent the first sign of pathological process a pathological change. Duration of a disease makes about 2 years, within the second year the cyst decreases in a size and disappears. The diagnosis is exposed on the basis of a X-ray analysis. Treatment is usually conservative: immobilization, punctures, introduction of medicines to a cavity of a cyst, LFK, physical therapy. At inefficiency of conservative therapy and danger of considerable destruction of a bone tissue the resection with the subsequent alloplastiky is made.
Bone cyst – a disease at which in a bone tissue the cavity is formed. The causes are unknown. Usually children and teenagers are ill. There are two types of cysts: solitary and anevrizmalny, the first are three times more often observed at boys, the second usually come to light at girls. The cyst in itself does not pose a threat for life and health of the patient, however can cause pathological changes and sometimes becomes the reason of development of a contracture of a nearby joint. At an anevrizmalny cyst in a vertebra emergence of neurologic symptomatology is possible. Treatment of bone cysts is performed by orthopedists and traumatologists.
Formation of a bone cyst begins with violation of blood circulation on the limited site of a bone. Because of shortage of oxygen and nutrients the site begins to collapse that leads to activation of the lizosomny enzymes splitting collagen, glikozaminoglikana and other proteins. The cavity filled with liquid with high hydrostatic and osmotic pressure is formed. It, and also a large amount of enzymes in liquid in a cyst, leads to further destruction of a surrounding bone tissue. In the subsequent pressure of liquid decreases, activity of enzymes decreases, from active the cyst turns in passive and over time disappears, being gradually replaced with a new bone tissue.
Solitary bone cyst
More often boys of 10-15 years suffer. At the same time, also earlier development is possible – in literature the case of a solitary cyst at the 2-month-old child is described. At adults bone cysts come to light extremely seldom and usually represent a residual cavity after not diagnosed disease postponed in the childhood. As a rule, cavities arise in long tubular bones, first place on prevalence is won by bone cysts of a proximal metafiz of a femoral and humeral bone. A course of disease at the initial stages in most cases asymptomatic, sometimes patients note an insignificant swelling and insignificant unstable pains. At children 10 years sometimes are aged younger the swelling is observed, contractures of the next joint can develop. At big cysts in the field of a proximal diaphysis of a hip lameness is possible, at damage of a humeral bone – discomfort and unpleasant feelings at the sharp movements and lifting of a hand.
The reason of the address to the doctor and the first symptom of a solitary bone cyst it becomes frequent the pathological change arising after insignificant traumatic influence. Sometimes the trauma does not manage to be revealed at all. At survey of the patient with initial stages of a disease local changes are not expressed. There is no hypostasis (an exception – hypostasis after a pathological change), there is no hyperaemia, the venous drawing on skin is not expressed, the local and general hyperthermia is absent. The insignificant atrophy of muscles can come to light.
At a palpation of an affected area in some cases it is possible to find a painless club-shaped thickening with a bone density. If the cyst reaches the considerable sizes, when pressing the wall of a cyst can cave in. In the absence of a change the active and passive movements in full, the support is kept. At violation of integrity of a bone the clinical picture corresponds to a change, however symptoms are expressed less brightly, than in case of usual traumatic damage.
In the subsequent the phasic current is noted. In the beginning the cyst is localized in a metafiza and connects to growth zone (a phase of an osteoliz). At cavities of the big size the bone in the place of defeat "is blown up", repeated pathological changes can develop. Formation of a contracture of a nearby joint is possible. In 8-12 months the cyst from active turns into passive, loses touch with a rostkovy zone, gradually decreases in sizes and begins to be displaced to a metadiaphysis (an otgranicheniye phase). In 1,5-2 from the beginning of a disease the cyst appears in a diaphysis and clinically is not shown in any way (a restoration phase). At the same time because of existence of a cavity bone durability in the place of defeat decreases therefore at this stage pathological changes are also possible. Either the small residual cavity, or the limited site of an osteosclerosis becomes an outcome. The absolute recovery is clinically observed.
For specification of the diagnosis carry out a radiological research of the struck segment: femur X-ray analysis, X-ray analysis of a humeral bone etc. On the basis of a radiological picture define a phase of pathological process. In a phase of an osteoliz in a picture the unstructured depression of a metafiz adjoining to growth zone is found. In an otgranicheniye phase on roentgenograms the cavity with the cellular drawing surrounded with a dense wall and separated from a zone of growth by the site of a normal bone is visible. In a restoration phase in pictures the site of consolidation of a bone tissue or a small residual cavity comes to light.
Anevrizmalny bone cyst
Meets less often than solitary. Usually arises at girls of 10-15 years. Can affect bones of a basin and vertebras, metafiza of long tubular bones suffer less often. Unlike a solitary bone cyst, as a rule, arises after a trauma. Formation of a cavity is followed by intensive pains and the progressing hypostasis of the struck area. At survey the local hyperthermia and expansion of hypodermic veins comes to light. At localization in bones of the lower extremities violation of a support is noted. The disease quite often is followed by development of a contracture of a nearby joint. At bone cysts in vertebras there are neurologic violations caused a sdavleniye of spinal backs.
Distinguish two forms of anevrizmalny bone cysts: central and eccentric. During a disease allocate the same phases, as well as at solitary cysts. Clinical manifestations reach a maximum in a phase of an osteoliz, gradually decrease in a phase of an otgranicheniye and disappear in a restoration phase. On roentgenograms in a phase of an osteoliz the unstructured center with an extra bone and intra bone component comes to light, at excentric cysts an extra bone part by the size exceeds intra bone. The periosteum is always kept. In an otgranicheniye phase between an intra bone zone and a healthy bone the site of a sclerosis is formed, and the extra bone zone is condensed and decreases in a size. In a restoration phase on roentgenograms the site of a giperostoz or a residual cavity is found.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Treatment is performed by children's orthopedists, in small settlements – traumatologists or children's surgeons. Even if the change is absent, recommend to unload an extremity, using crutches (at damage of the lower extremity) or having suspended a hand on a kosynochny bandage (at damage of the top extremity). At a pathological change impose plaster for a period of 6 weeks. To accelerate maturing of opukholevidny education, carry out punctures.
Contents of a cyst are deleted, using special needles for intra bone anesthesia. Then carry out multiple perforation of walls for pressure decrease in a cyst. The cavity is washed out the distilled water or physical solution for removal of products of splitting and enzymes. Then carry out washing of 5% solution of e-aminocaproic acid for neutralization of a fibrinoliz. At the final stage enter into a cavity . At a big cyst at patients 12 years perhaps introduction of a triamtsinolon or hydrocortisone are more senior. At active cysts the procedure is repeated 1 time in 3 weeks, at closed – 1 time in 4-5 weeks. Usually 6-10 punctures are required.
During treatment regularly carry out . At emergence of signs of reduction of a cavity of the patient direct to LFK. At inefficiency of conservative therapy, threat of a sdavleniye of a spinal cord or risk of considerable destruction of a bone surgical treatment – a regional resection of an affected area and an alloplastik of the formed defect is shown. In an active phase when the cyst is connected to growth zone, operations are performed only in extreme cases as the risk increases to damage a rostkovy zone that is fraught with lag of growth of an extremity in the remote period. Besides, at contact of a cavity with a rostkovy zone the risk of development of a recurrence increases.
The forecast is usually favorable. After reduction of a cavity there occurs recovery, working capacity is not limited. The remote consequences of cysts can be caused by formation of contractures and massive destruction of a bone tissue with shortening and deformation of an extremity, however at timely adequate treatment and observance of recommendations of the doctor such outcome is observed seldom.