计算机导航辅助经皮射频消融治疗骨样骨瘤13例报告  

Computer navigation-guided percutaneous radiofrequency ablation of the osteoid osteomas:13-case report

作　　者：鱼锋[1] 张清[1] 赵海涛[1] 徐立辉[1] 牛晓辉[1] 

机构地区：[1]北京积水潭医院骨肿瘤科,100035

出　　处：《中国骨与关节杂志》2014年第2期152-155,共4页Chinese Journal of Bone and Joint

摘　　要：目的：探讨计算机导航技术辅助经皮射频消融治疗骨样骨瘤手术方法和临床效果。方法回顾性分析2011年6月至2012年11月，我科应用计算机导航辅助经皮射频消融治疗骨样骨瘤13例的临床资料，其中男12例，女1例，平均16.5（8～36）岁。术前均经局部X线、CT、MRI明确诊断。肿瘤位于股骨干4例、股骨粗隆2例、股骨颈2例、股骨髁2例、胫骨干2例、跟骨1例。13例均采用Iso-C 3D C型臂术中实时导航，计算机软件均使用Stryker公司的脊柱导航软件。术中导航指引定位，骨活检针（9G ）精确到达瘤巢，行穿刺活检，保留套筒，将射频针导入瘤巢，90℃消融6 min。术后进行随访，并采用疼痛视觉类比评分法（ VAS ）和术后X线、CT判断疗效。结果13例均获11.2（4～20）个月的随访。全部病例均完成计算机导航辅助下射频消融手术，11例组织病理学确诊为骨样骨瘤，2例组织学无法诊断，病理确诊率85%。术后疼痛即刻缓解，VAS评分显著降低。术前平均4.7，术后3天1.3，术后3个月为0.1，差异有统计学意义（ P＜0.05）。全部病例随访未见肿瘤复发和疼痛复发。结论经皮射频消融治疗骨样骨瘤是一种简单、安全、有效的治疗方法。计算机导航技术的应用，使术中瘤巢定位更精确，使手术治疗的微创化成为现实。Objective To investigate the surgical method and clinical results of computer navigation-guided percutaneous radiofrequency ablation （ RFA ） in the treatment of osteoid osteomas. Methods From June 2011 to November 2012, 13 patients with osteoid osteomas were treated with computer navigation-guided percutaneous RFA, whose clinical data were retrospectively analyzed. There were 12 men and 1 woman with a mean age of 16.5 years old （ range;8-36 years ）. Preoperatively all the diagnoses were conifrmed by the local X-ray, CT and MRI examinations. The femoral diaphysis was the most common site involved （ n=4 ）, followed by the femoral trochanter （ n=2 ）, the femoral neck （ n=2 ）, the femoral condyle （ n=2 ）, the tibial diaphysis （ n=2 ） and the calcaneus （ n=1 ）. The intraoperative scanning with the C-arm Iso-C three-dimensional （ 3-D ） system （ Siemens ） was performed and the spine navigation system （ Stryker ） was used in all the cases. The core needle biopsy （ 9G ） which was guided by the navigation system was performed in the nidus, and the the outer sleeve was reserved as an access for the radiofrequency needle. The RFA was performed at 90℃for 6 minutes. All the patients were followed up postoperatively. The Visual Analogue Scale （VAS） was used before and after the surgery, and the X-ray and CT examinations were performed after the surgery to evaluate the results. Results All the 13 patients were followed up for 11.2 months on average （ range;4-20 months ）, and they all underwent computer navigation-guided RFA successfully. Histopathological examination revealed 11 cases of osteoid osteomas and 2 cases of no diagnosis, and the pathological diagnosis rate was 85%. The postoperative pain got relieved instantly. The VAS scores were signiifcantly reduced, which were 4.7 points, 1.3 points and 0.1 points on average preoperatively and at 3 days and 3 months after the operation respectively, and the differences were statistically signiifcant （ P＆lt;0.05 ）. Ne

关 键 词：骨瘤 骨样 治疗 计算机辅助 导管消融术 脉冲射频术 

分 类 号：R738.1[医药卫生—肿瘤]