Roslavtsev A. Prevention and treatment of recurrences aneurysmal bone cysts among children and adolescents

The thesis is devoted to the problem of Pediatric Orthopaedics: improvement of treatment results of children and adolescents with aneurysmal bone cysts (ABC) by developing an algorithm in treatment and a new surgical treatment method. The work is based on the clinical and radiographic indications among 164 patients and morphologic peculiarities of focus in 94 cases of ABC of histobiopsy. As a result of the retrospective analysis of the surgical treatment of patients with ABC the main factors, that influence on the increasing incidence of disease, have been found such as: patient's age when the surgical treatment has been effected, the number of these treatments, topographical type of the focus, cliniko-radiological type according to W. F. Enneking and topografo-radiological type of ABC according to R. Capanna. There have been found the morphological indications which in total can characterize pathological changes in tissues of primary and recurrent aneurysmal bone cysts, there have been analyzed the frequency rates of these indications of different groups and subgroups under analysis, and therefore, the unknown and unobvious differences and correlations have been defined. Quantitative parameters of the defined correlations may be used for prediction of focus tissue of ABC, according to some clinical and clinico-visualized indications in some part of observations. There has been suggested the algorithm for patients treatment that is based on the consideration of all the factors that lead to increasing incidence of recurrences. Based on current understanding of aetiology and a pathogenesis there has been developed and well-grounded a new method of surgical treatment that is aimed to break the so-called "vicious circle" of ABC by decompression of pathological focus. Application of the developed algorithm of treatment and a new surgical method has greatly reduced the percentage of recurrences.