Method of Transosseous Through-and-Through Drainage of Bone Cysts

The aim of the investigation was to develop a method of treatment of degenerative bone cysts localized in the double-beam segments of the limbs.

Materials and Methods. We proposed a method ofthrough-and-through drainage of degenerative bone cysts in double-beam segments of the limbs with the insertion of puncture needles through the unaffected radius. The transosseous introduction of the needles is achieved under a certain angle of osteoperforation: the distal needle — under the 15 to 30º posterior angulation, and the proximal needle — under 15 to 30º anterior angulation. The needles are arranged in the following way: the distal one is placed in the anteroinferior part of the cyst, and the proximal one is placed in the posterosuperior part of the cyst more distally from theenostosis, that apart from secure fixation enables the overall irrigation of the cavity of the pathological focus.

The proposed method is applied to 8 patients with localization of the pathological process in the bones of the lower leg and forearm. Transosseous drainage was carried out for 7–10 days with successive change of the perfusion drugs.

Results. The needle fixation in all patients was good, the outflow of the therapeutic mixture into the surrounding soft tissues was not observed. During the drainage the patients did not complain, no complications were observed.

Conclusion. The transosseous method ofthrough-and-throughdrainage of bone cysts enables to achieve secure fixation of puncture needles and avoid complications.

1. Demichev N.P., Tarasov A.N. Diagnostika i kriokhirurgiya kostnykh kist [Diagnosis and cryosurgery of bone cysts]. Moscow: MEDpress-inform; 2005; 144 p.
2. Snetkov A.I. Opyt diagnostiki i lecheniya kist kostey u detey. V kn.: Materialy tret’ego Rossiyskogo nauchnogo foruma “Khirurgiya 2001” [Experience of diagnosis and treatment of bone cysts in children. In: Proceedings of the third Russian scientific forum “Surgery 2001”]. Moscow; 2001; p. 207–208.
3. Altermatt S., Schwöbel M., Pochon J.P. Operative treatment of solitary bone cysts with tricalcium phosphate ceramic. A 1 to 7 year follow-up. Eur J Pediatr Surg 1992; 2(3): 180–182, http://dx.doi.org/10.1055/s-2008-1063435.
4. Albrektsson T. Hydroxyapatite-coated implants: a case against their use. J Oral Maxillofac Surg 1998; 56(11): 1312–1326, http://dx.doi.org/10.1016/s0278-2391(98)90616-4.
5. Tenilin N.A., Bogos’yan A.B., Sosnin A.G. The treatment of degenerative bone cysts. Travmatologiya i ortopediya Rossii 1995; 5: 27–30.
6. Andreev P.S. Diagnostika i lechenie anevrizmal’nykh kostnykh kist dlinnykh kostey u detey. V kn.: Aktual’nye voprosy detskoy travmatologii i ortopedii [Diagnosis and treatment of aneurysmal cysts of the long bones in children. In: Current issues of pediatric traumatology and orthopedics]. Moscow; 2001; p. 166–167.
7. Althof P.A., Ohmori K., Zhou M., Bailey J.M., Bridge R.S., Nelson M., Neff J.R., Bridge J.A. Cytogenetic and molecular cytogenetic findings in 43 aneurysmal bone cysts: aberrations of 17p mapped to 17p13.2 by fluorescence in situ hybridization. Mod Pathol 2004; 17(5): 518–525, http://dx.doi.org/10.1038/modpathol.3800090.
8. Kuftyrev L.М., Luniova S.N., Pozharishchensky K.E., Zlobin А.V., Yerofeyeva Т.N. Biochemical study of blood serum in patients with bone cysts. Geniy ortopedii 2002; 1: 77–80.
9. Amling M., Werner M., Pösl M., Ritzel H., Welkerling H., Wening J.V., Maas R., Winkler K., Heise U., Delling G. Solitary bone cysts. Morphologic variation, site, incidence and differential diagnosis. Pathologe 1996; 17(1): 63–67.
10. Sadof’eva V.I., Gudushauri M.O. Roentgenologic diagnosis of dystrophic cysts in children. Ortopediya, travmatologiya i protezirovanie 1991; 12: 30–32.
11. Mitrofanov A.I., Borzunov D.Yu. Results of treatment in patients with active solitary bone cysts using transosseous osteosynthesis. Geniy ortopedii 2010; 2: 55–59.
12. Watanabe H., Arita S., Chigira M. Aetiology of a simple bone cyst. A case report. Int Orthop 1994; 18(1): 16–19.
13. Ordo Deus. URL: http://www.ordodeus.ru/Ordo_Deus12_Osteoblastoklastoma.html.
14. Vybornov D.Yu., Borkhunova Ye.N., Koroteyev V.V., Petrov M.A. The etiology, pathogenesis, diagnosis of osseous cysts in children. Detskaya khirurgiya 2003; 1: 34–36.
15. Berchenko G.N. "Solidnyy" variant anevrizmal’noy kisty kosti u detey i podrostkov. V kn.: Aktual’nye voprosy detskoy travmatologii i ortopedii [“Solid” variant of aneurismal bone cyst in children and adolescents. In: Current issues of pediatric traumatology and orthopedics]. Saint Petersburg; 2000; p. 219–220.
16. Erol B., Onay T., Çalışkan E., Aydemir A.N., Topkar O.M. Treatment of pathological fractures due to simple bone cysts by extended curettage grafting and intramedullary decompression. Acta Orthop Traumatol Turc 2015; 49(3): 288–296, http://dx.doi.org/10.3944/AOTT.2015.14.0108.
17. Klimovitsky V.G., Zhilitsyn Ye.V., Chuguy Ye.V., Ilyushenko Yu.K., Aleschenko I.Ye. Treatment of bone cysts of different localization in children. Travma 2012; 13(3): 9–11.
18. Scaglietti O., Marchetti P.G., Bartolozzi P. The effects of methylprednisolone acetate in the treatment of bone cysts. Results of three years follow-up. J Bone Joint Surg Br 1979; 61-B(2): 200–204.
19. Berezhnyy A.P., Nechvolodova O.L., Vilenskiy E.V. The outcomes of conservative treatment of solitary and aneurysmal bone cysts in children. Ortopediya, travmatologiya i protezirovanie 1988; 2: 5–7.
20. Burkova L.M. Patogeneticheskoe obosnovanie konservativnogo lecheniya kist kostey u detey. V kn.: Organizatsiya i lechenie detey s ortopedicheskimi zabolevaniyami i travmami [Pathogenetic substantiation of conservative treatment of bone cysts in children. In: Organization and treatment of children with orthopedic diseases and traumas]. Leningrad: Meditsina; 1990; p. 111–112.
21. Bogos’yan A.B., Tenilin N.A., Sosnin A.G. Sposob lecheniya kostnykh kist [The method of treatment of bone cysts]. Patent RU 2069995. 1996.

Shelyakhin V.E., Vlasov M.V., Tenilin N.A. Method of Transosseous Through-and-Through Drainage of Bone Cysts. Sovremennye tehnologii v medicine 2016; 8(2): 71, https://doi.org/10.17691/stm2016.8.2.10