Sakroiliak bölge yerleşimli iliak kemik kistleri: Sakroiliak ağrının nadir görülen bir nedeni

Abstract

Amaç: Bu çalışmada nadir görülen bir sakroiliak eklem kaynaklı ağrı nedeni olarak iliak kemiğin sakroiliak eklem komşuluğunu tutan kistik kemik lezyonlarını tanımlamayı amaçladık.

Çalışma planı: Enneking ve Dunham’a göre Zon 1 yerleşiminde selim kistik kemik lezyonu bulunan ve iki yıllık takibi olan 9 hasta çalışmaya dahil edildi. İleri radyolojik inceleme manyetik rezonans görüntüleme veya bilgisayarlı tomografi ile yapıldı. Tüm hastalara genişletilmiş küretaj, fenol ve termal koterizasyon ile adjuvan tedavi ve otogreft/allogreft kemik ile greftleme uygulandı. Hastalar lezyon başlangıcındaki yaş, lezyonun bulunduğu taraf, klinik ve radyolojik bulgular, tümör evresi, komplikasyonlar ve son kontrollerindeki klinik ve radyolojik bulgular açısından incelendi.

Bulgular: Kadın hastaların erkek hastalara oranı 4/5 idi. Tanı anında ortalama yaş 40.3 (dağılım: 27-54) iken, ortalama lezyon çapı 6.6 (dağılım: 4-11) cm olarak saptandı. Bir olguda yüzeysel enfeksiyon, iki olguda insizyon çevresinde hipoestezi meydana geldi. Tüm hastalarda ağrı ve aksama şikayetlerinde düzelme rapor edildi. Ortalama 30.7 (dağılım: 21-40) aylık takip sonrası radyolojik olarak nüks gözlenmedi.

Çıkarımlar: Sakroiliak eklem kaynaklı ağrının ayırıcı tanısında selim tümör benzeri kistik kemik lezyonları göz önünde bulundurulmalıdır. Bu tür lezyonlar genişletilmiş intralezyonel küretaj, lokal adjuvan tedaviler ve greftleme ile güvenli ve etkin bir şekilde tedavi edilebilmektedir.

Keywords

• Anevrizmal kemik kisti; basit kemik kisti; pelvis; sakroiliak ağrı.

Iliac bone cysts adjacent to the sacroiliac joint:an unusual cause of sacroiliac pain

Abstract

Objective: The aim of this study was to describe cystic bone lesions involving the sacroiliac region of the iliac bone as a rare cause of sacroiliac joint-related pain.

Methods: The study included 9 patients with benign cystic bone lesion in Zone 1 according to Enneking and Dunham with a minimum of 2 years follow-up. Detailed radiological examination was performed using magnetic resonance imaging or computed tomography. Extended curettage, adjuvant treatment with phenol and thermal cauterization and bone grafting with auto/allografts were performed. Patients were analyzed for age of onset, side of involvement, clinical and radiological findings, tumor stage, complications and clinical/radiological findings at the final follow-up.

Results: Female to male ratio was 4 to 5. Average age at the time of diagnosis was 40.3 (range: 27 to 54) years. Average diameter of the lesion was 6.6 (range: 4 to 11) cm. Superficial infection was detected in one patient and hypoesthesia around the site of incision in two. Clinical improvement in pain and limp was reported in all patients. No radiological recurrence was detected after an average follow-up time of 30.7 (range: 21 to 40) months.

Conclusion: Benign tumor-like cystic lesions should be kept in mind in the differential diagnosis of sacroiliac joint-related pain. Such lesions can be safely and effectively managed with intralesional curettage, local adjuvant methods and bone grafting.

Keywords

• Aneurysmal bone cyst
• pelvis
• sacroiliac pain
• simple bone cyst

References

1. Schwarzer AC, Aprill CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine 1995;20:31-7.
2. Andersson GB. Epidemiological features of chronic lowback pain. Lancet 1999;354:581-5.
3. Van der Wurff P, Meyne W, Hagmeijer RH. Clinical tests of the sacroiliac joint. Man Ther 2000;5:89-96.
4. Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N. The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine 1996;21:259460
5. McKenzie-Brown AM, Shah RV, Sehgal N, Everett CR. A systematic review of sacroiliac joint interventions. Pain Physician 2005;8:115-25.
6. Foley BS, Buschbacher RM. Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment. Am J Phys Med Rehabil. 2006;85:997-1006.
7. Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am 1978;60:731-46.
8. Bloem JL, Reidsma II. Bone and soft tissue tumors of hip and pelvis. Eur J Radiol 2012;81:3793-801.

9. Zehetgruber H, Bittner B, Gruber D, Krepler P, Trieb K, Kotz R, et al. Prevalence of aneurysmal and solitary bone cysts in in young patients. Clin Orthop Relat Res 2005;439:136-43.
10. Unni KK. Dahlin’s bone tumors: general aspects and data on 11,087 cases. 5th ed. Philadelphia: Lippincott-Raven; 19 P. 382-90. Mankin HJ, Hornicek FJ, Ortiz-Cruz E, Villafuerte J, Gebhardt MC. Aneurysmal bone cyst: a review of 150 patients. J Clin Oncol 2005;23:6756-62.
11. Abdelwahab IF, Hermann G, Norton KI, Kenan S, Lewis MM, Klein MJ. Simple bone cysts of the pelvis in adolescents. A report of four cases. J Bone Joint Surg Am 1991;73:1090-4.
12. Samuelson KM, Momberger GL, Coleman SS. Solitary bone cyst of the ilium. Report of two cases and a review of the literature. Rocky Mt Med J 1975;72:443-5.
13. Papagelopoulos PJ, Choudhury SN, Frassica FJ, Bond JR, Unni KK, Sim FH. Treatment of aneurysmal bone cysts of the pelvis and sacrum. J Bone Joint Surg Am 2001;83A:1674-81.
14. Hammoud S, Weber K, McCarthy EF. Unicameral bone cysts of the pelvis: a study of 16 cases. Iowa Orthop J 2005;25:69-74.
15. Sim FH, Dahlin DC, Stauffer RN, Laws ER Jr. Primary bone tumors simulating lumbar disc syndrome. Spine 1977;2:65-74.
16. Tehranzadeh J, Mnaymneh W, Ghavam C, Morillo G, Murphy BJ. Comparison of CT and MR imaging in musculoskeletal neoplasms. J Comput Assist Tomogr 1989;13:466-72.
17. Pettersson H, Gillespy T 3rd, Hamlin DJ, Enneking WF, Springfield DS, Andrew ER, et al. Primary musculoskeletal tumors: examination with MR imaging compared with conventional modalities. Radiology 1987;164:237-41.
18. Zimmer WD, Berquist TH, Sim FH, Wold LE, Pritchard DJ, Shives TC, et al. Magnetic resonance imaging of aneurysmal bone cyst. Mayo Clin Proc 1984;59:633-6.
19. Mahnken AH, Nolte-Ernsting CC, Wildberger JE, Heussen N, Adam G, Wirtz DC, et al. Aneurysmal bone cyst: value of MR imaging and conventional radiography. Eur Radiol 2003;13:1118-24.
20. Hou HY, Wu K, Wang CT, Chang SM, Lin WH, Yang RS. Treatment of unicameral bone cyst: surgical technique. J Bone Joint Surg Am 2011;93 Suppl 1: 92-9.
21. Lokiec F, Ezra E, Khermosh O, Wientroub S. Simple bone cysts treated by percutaneous autologous marrow grafting. A preliminary report. J Bone Joint Surg Br 1996;78:934
22. Tsuchiya H, Abdel-Wanis ME, Uehara K, Tomita K, Takagi Y, Yasutake H. Cannulation of simple bone cysts. J Bone Joint Surg Br 2002;84:245-8.
23. Bovill DF, Skinner HB. Unicameral bone cysts. A comparison of treatment options. Orthop Rev 1989;18:420-7. Wilkins RM. Unicameral bone cysts. J Am Acad Orthop Surg 2000;8:217-24.
24. Rapp TB, Ward JP, Alaia MJ. Aneurysmal bone cyst. J Am Acad Orthop Surg 2012;20:233-41.
25. Başarir K, Pişkin A, Güçlü B, Yildiz Y, Sağlik Y. Aneurysmal bone cyst recurrence in children: a review of 56 patients. J Pediatr Orthop 2007;27:938-43.
26. Wolf RE, Enneking WF. The staging and surgery of musculoskeletal neoplasms. Orthop Clin North Am 1996;27:473-81.