Use of cement combined grafting in upper and lower extremity benign bone tumors

AIM: To evaluate the efficiency of DBM (Demineralized Bone Matrix) application on cemented bone part after curettage of benign bone tumors. MATERIAL-METHOD: In our study, 32 patients were included with extremity benign bone tumor diagnosis between February 2010-2014. Bones with benign tumor were treated with DBM on cement after curettage and cementization, respectively. Patients were followed-up at least 1 year. The patients' characteristics are recorded as age, gender, tumor localization and side, histopathologic diagnosis, Enneking Phase, tumor size, size of the separated bone part to reach the tumor, usage of prophylactic fixation, time of return to job, MSTS functional score, tumor relapse if there is any and effect of DBM in terms of bone development stimulation in the BT in one year after operation. Shapiro-Wilk test is used to analyze the normal distribution of the data. Kruskal-Wallis test is used to compare more than two groups without normal distribution, whereas Mann-Whitney test is used to compare two independent groups. Relationship between parameters without normal distribuiton is evaluated with Spearman Correlation coefficient. FINDINGS: Out of all patients in our study, 19% had simple bone cyst, 44% enchondroma, 3% aneurysmal bone cyst, 3% fibrous dysplasia, 9% NOF, 3% chondroblastoma and 19% giant cell bone tumor. 23 patients did not have prophylactic fixation and 9 patients were stabilized with plate. Median tumor volume was 17,2cm3 (2,8-139,6), median area of the cortical window was 8,3cm2 (1,6-28,4) and median postoperative MSTS score was 84,5 (66-97). Median bone regeneration in the BT in one year after operation was Phase 2 and 10 patients had Phase 4 bone regeneration, which is almost the whole of the separated bone part. Functional results are significantly worse with prophylactic fixation usage (p<0.001) and a statistically significant difference is identified between fixation usage and separated bone part size (p=0.013). Lower level negative correlation in terms of age and bone regeneration is found (p:0.046, r:-0.356). Mid level negative correlation is found between time of return to job and functional scores (p:0.004, r:-0.498) as well as between separated bone part size and functional scores (p:0.001, r:-0,577). Only one patient had giant cell bone tumor as a complication. DISCUSSION-CONCLUSION: DBM application on cement after curettage of bone tumors is an effective and biological treatment method. This method can be further researched and analyzed. We have the opinion that this study will provide an insight to the future tumor treatment methods if it is going to be histologically supported by controlled studies.