الفهرس 
Surgical margins & treatmentOnly 14 pages are availabe for public view
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Abstract
Background & purpose: Extended curettage is one of the most common treatment options for benign lytic bone tumors and tumor like lesions. The resultant defect is usually filled. We report our outcome curettage of benign bone tumors and tumor like lesions & whether or not to fill the defect. Patients & methods: We prospectively studied 40 patients (24 males and 16 females) with benign bony cystic tumors who had undergone extended curettage. They were divided into two groups according to the method of reconstruction using either autologous bone grafting in 20 patients (group A) or without grafting or filling of the defect by any other bone graft substitute in the other 20 patients (group B). The mean age of the patients was 16.4 years in group A and was 17.9 years in group B. The most common histological diagnosis was aneurysmal bone cyst (ABC) (20 cases: 11 in group A & 9 in group B) followed by enchondroma (5 cases: 2 in group A & 3 in group B) & simple bone cyst (5 cases: 1 case in group A & 4 cases in group B). The most common anatomical site was the tibia (7 cases: 5 in group A & 2 in group B) and the humerus (7 cases: 3 in group A & 4 in group B). The mean volume (in cm3) of bone defect after tumor resection was 39.8cm3 in group A & 26.9cm3 in group B. The plain radiographs & CT scan of the part before and after curettage were reviewed to establish the size of the initial defect and the rate of reconstitution, filling and remodeling of the bone defect. Patients were reviewed every 3 monthly for a minimum period of 1 year. Regular outpatient follow-up was done with a mean period of 19.8 (12-28) months in group A and 18.6 (12-30) months in group B. Results: Most of the bone defects completely reconstituted to a normal appearance while the rest filled partially. 2 cases in group A suffered intra-operative complications (sciatic neuroapraxia, pathological fracture). The MSTS score range was from 28 % to 100 % with a mean value of 88.9 % in group A and was from 15 % to 100 % with a mean value of 77.5 % in group B. Post-operative pathological fracture was present in 5% of cases of group A & 20% of cases of group B, while non union was present in 10% of cases of group A, all of them being reoperated. Conclusion: This study demonstrates the natural healing ability of bone without filling with bone grafts or bone graft substitutes. Both techniques are valuable biological choices in the management of bony defects following extended curettage of benign cystic lesions, but operative time was longer in the grafting group while cavity filling was higher also in the grafting group.