手术机器人引导经皮穿刺射频消融治疗骨样骨瘤  

Application of robot-assisted percutaneous radiofrequency ablation in the management of osteoid osteoma

作　　者：李勇 买吾兰[2] 郭龙轩 晏琼 雷军 蔡林[2] 邓洲铭[2] Li Yong;Mai Wulan;Guo Longxuan;Yan Qiong;Lei Jun;Cai Lin;Deng Zhouming(Department of Orthopedics,Taihe Hospital,Hubei University of Medicine,Shiyan Hubei,442000;Department of Spine Surgery and Musculoskeletal Tumor,Zhongnan Hospital of Wuhan University,Wuhan Hubei,430071;Department of Orthopedics,Dawu Second Hospital,Dawu Hubei,432800,China)

机构地区：[1]湖北省十堰市太和医院骨科(湖北医药学院附属医院),湖北十堰442000 [2]武汉大学中南医院脊柱骨肿瘤科,湖北武汉430071 [3]湖北省大悟县第二人民医院骨科,湖北大悟432800

出　　处：《生物骨科材料与临床研究》2024年第2期16-20,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨骨科手术机器人辅助经皮射频消融治疗骨样骨瘤手术的临床疗效。方法回顾性分析2021年6月至2023年4月武汉大学中南医院脊柱骨肿瘤科应用骨科手术机器人辅助经皮射频消融治疗骨样骨瘤10例患者的临床资料。其中,男6例,女4例;年龄8~33岁,平均20.8岁。术前所有患者均完善了X线、CT及MRI检查。肿瘤发病部位股骨颈4例、髋臼2例、股骨粗隆间1例、尺骨1例、胸椎椎板1例,第4掌骨1例。所有病例均采用骨科手术机器人进行术中三维扫描及规划,先利用骨活检针行穿刺活检,然后更换套筒,将射频针导入瘤巢,射频参数设置为90℃,时间6 min。采用疼痛视觉类比评分法(VAS)进行术前、术后疼痛评价。结果10例患者均获得平均16个月(5~26个月)的随访。全部病例均顺利完成骨科手术机器人引导下射频消融手术,9例患者术后组织病理学确诊为骨样骨瘤,1例因样本量少组织学无法诊断。患者术后疼痛即刻缓解,术前VAS评分为(6.40±1.58)分,术后1 d、3个月的VAS评分分别为(2.40±1.35)分和(0.40±0.52)分,术前、术后比较差异有统计学意义(P<0.05)。患者围手术期均未出现伤口感染等并发症,平均住院时间为3.4 d。全部病例随访未见肿瘤复发和疼痛再现。结论经皮穿刺射频消融治疗骨样骨瘤具备简单、安全及有效的特点。骨科手术机器人导航技术的应用使术中定位更精确。Objective To investigate the therapeutic efficacy of robot-assisted percutaneous radiofrequency ablation in the management of osteoid osteoma.Methods From June 2021 to April 2023,a total of 10 patients were enrolled in this study.Their clinical data were analyzed.There were 6 males and 4 females with a mean age of 20.8 years old(range 8-33 years).Preoperatively,all the cases were detected by local X-ray,CT and MRI examinations.The femoral neck was the most common pathogenic site involved(n=4),followed by the acetabulum(n=2),the femoral intertrochanteric(n=1),the ulna(n=1),the lamina of the thoracic vertebra(n=1)and the fourth metacarpal bone(n=1).All the cases were scanned and biopsied under the guidance of robotic system,then radiofrequency ablation was implemented.The visual analogue scale(VAS)was used to evaluate therapy response before and after the surgery.Results All 10 cases were followed up for a mean of 16 months(range 5-26 months)and all underwent successful robotic-assisted percutaneous radiofrequency.Nine patients were confirmed to have osteoid osteoma by pathologic examination,1 patient without diagnosis due to insufficient sample.Postoperative pain was relieved immediately.The VAS scores were significantly reduced,which were(6.40±1.58)points before surgery,and(2.40±1.35)points and(0.40±0.52)points at 1 d and 3 months after surgery respectively,and the difference was statistically significant(P<0.05).No tumor or pain recurrence was observed in any of the patients during the follow-up.Conclusion Percutaneous radiofrequency ablation had a satisfactory effect in the management of osteoid osteoma,which was a safe and minimally invasive treatment.The application of robotic system makes this treatment more accurate.

关 键 词：骨样骨瘤 射频消融 手术机器人 

分 类 号：R738.1[医药卫生—肿瘤]