الفهرس 
Review of Literature
Bone graftingOnly 14 pages are availabe for public view
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Abstract
he aim of this work is to compare whether to use bone graft or bone substitutes after extended curettage of benign cystic lesions as regards functional, radiological outcomes and possible complications.
Extended curettage is the commonest mode of the treatment of the cavitary benign bone tumors. If a tumor is very large and threatening to involve the joint, complete excision with joint reconstruction may be necessary. Cure rates of 90‑95% have been achieved using curettage as the sole mode of treatment in benign bony lesions. (51, 97) However this treatment is not devoid of controversy and many authors recommend that bone defect after curettage of benign bone tumors should be filled with bone grafts or substitutes such as cement, hydroxyapatite, or tricalcium phosphate. (85)
Autografts are free of disease transmission or immunological reactions and have properties of osteogenesis, osteoinduction and osteoconduction, but are associated with the donor site morbidity (54).
PMMA is inert and non biodegradable so it persists within the bone cavity and provides instant stability and sufficient quantity for large tumor cavities; its exothermic reaction kills tumor cells and causes less recurrence. (41) PMMA facilitates early radiographic detection of recurrence by increasing resorption of bone and pain at that site. The risk of thermal damage with PMMA use is the major concern as it may damage cartilage and subchondral bone leading to degenerative arthritis. (98, 99) However, a recent long-term follow-up study of cemented giant cell tumors did not show that there was a high risk of osteoarthritis development. (100) The long term persistence of PMMA may influence the rate of bone remodeling by affecting bone metabolism and trabeculae may be weakened by change in mechanical environment. (99)
Bone graft substitutes like calcium phosphate and hydroxyapatite are available. Although, sufficient amount is available but high cost is another factor limiting its use. There is no consensus, neither any literature nor any controlled clinical trial to support the efficacy of bone cements or any bone cement substitutes. (102) There is a little or may be no clinical prospective studies comparing the bone grafting to the bone substitute technique of management of benign bony cystic lesions from the functional & radiological points of view, but there are some retrospective case series which analyzed outcomes of the use of bone substitutes technique of management (69, 83).
The clinical studies that have been performed and included in our systematic review indicates that calcium sulfate resorbs too quickly, HA resorbs too slowly and blocks new bone ingrowth, and β-TCP and mineral bone graft composites have the biochemical profile that is most compatible with new bone formation. This study also indicates that all of the bone substitutes are safe and may be as effective as other bone graft options and with no limitation in its source for filling the large defects.