Summary
A corticocancellous core was removed from the lateral condyle of both femurs in 26 skeletally mature dogs. The cavity was treated with cryosurgery, phenol cautery or packing with bone cement. The animals were killed after 1, 4, and 12 weeks in the phenol and cement groups, and also after 24 weeks in the cryosurgery group. The extent of the bone necrosis and healing was assessed in each group. After cryosurgery the extent of necrosis was profound in that the area of damage was 365% compared to the area of the cavity; the depth of necrosis extended between 2.5 and 14 mm, beyond the cavity wall. The effect of phenol was negligible in that only microscopic areas of superficial focal necrosis were found around the cavity wall. Bone cement produced an area of necrosis of 153% compared with the cavity, with a depth of between 1.3 and 2.8 mm. Regeneration in the region of necrosis after cryosurgery was only scanty by 4 weeks, but by 12 weeks considerable areas of regeneration were identified and complete healing was observed by 24 weeks. Regeneration of the necrotized bone produced by bone cement packing was rapid and similar to that of the control specimens. These findings suggest that cryosurgery could play a significant role as a surgical adjunct to curettage in locally aggressive benign bone tumours and in some malignancies. Phenol cautery is not regarded as an adequate treatment after curettage of bone tumours. Although the extent of necrosis was relatively small, packing with bone cement is thought to be a useful choice in benign cases.
Résumé
Sur 26 chiens adultes, on a réalisé une perte de substance cortico-spongieuse dans le condyle externe de chaque fémur (soit 52 fémurs), et la cavité ainsi créée a été traitée par cryochirurgie, cautérisation au phénol ou obturation par du ciment osseux. Les animaux ont été sacrífiés après 1, 4, 12 semaines (et 24 semaines pour le groupe traité par cryochirurgie) afin de comparer l'étendue de la nécrose lìée à chaque traitement, et d'observer le processus de cicatrisation. Après cryochirurgie, la nécrose était profonde et intéressait une épaisseur de 2.5 à 14 mm autour de la cavité osseuse, représentant en moyenne 365% du volume de la cavité initiale. L'action du phénol était négligeable, car seuls quelques foyers nécrotiques microscopiques ont été observés sur les parois de la cavité. L'obturation par du ciment osseux entraînait une zone de nécrose d'une épaisseur régulière de 1.3 à 2.8 mm autour de la cavité, représentant en moyenne 153% de la cavité d'origine. La régénération des tissus dans la zone nécrosée après cryochirurgie était minime jusqu'à 4 semaines. Cependant après 12 semaines des zones de régénération étaient nettement identifiables en quantité importante, et la cicatrisation était presque complète à la 24é semaine. Le régénération de l'os nécrosé après obturation par du ciment osseux était rapidement identique aux spécimens de contrôle. Ces observations permettent de penser que la cryochirurgie pourrait jouer un rôle significatif comme complément du curetage, dans les tumeurs osseuses localisées, bénignes ou malignes. Par contre la cautérisation par le phénol ne semble pas un traitement adéquat. Enfin, bien que l'étendue de la nécrose soit relativement limitée, l'obturation par le ciment osseux peut être considérée comme utilisable dans les cas bénins.
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Yun, Y.H., Kim, N.H., Han, D.Y. et al. An investigation of bone necrosis and healing after cryosurgery, phenol cautery or packing with bone cement of defects in the dog femur. International Orthopaedics 17, 176–183 (1993). https://doi.org/10.1007/BF00186382
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DOI: https://doi.org/10.1007/BF00186382