CT引导下经皮穿刺切除骨样骨瘤

CT guided percutaneous removal of osteoid osteoma

目的 介绍CT引导下经皮穿刺切除骨样骨瘤的手术方法及临床疗效。方法 对1 1例临床和影像学检查诊断为骨样骨瘤患者进行CT引导下经皮穿刺切除术,瘤巢部位分别为:股骨近端7例、髋臼3例、肱骨头1例;操作步骤为:①对整个瘤巢采用1～3mm层厚 距的扫描,选择穿过瘤巢中心的层面和手术路径;②将导引用的克氏针钻入瘤巢内;③沿克氏针将套筒引入至骨皮质;④经套筒沿克氏针,采用环钻将整个瘤巢切除;⑤CT扫描复查确定是否已将整个瘤巢切除。结果 1 0例患者在治疗后2 4～4 8h内原来性状的疼痛消失,患者住院时间7d。在3～1 2个月(平均7.9个月)随访中均无疼痛复发。1 0例有最后典型病理表现而经病理确诊,另1例,其切除病理标本中未发现有典型骨样骨瘤表现,但在治疗后6个月的随访中,疼痛消失。1 1例均无严重并发症。结论 CT引导下经皮穿刺切除骨样骨瘤是一种简单有效、安全可靠的微创性治疗方法。

Objective To introduce the methods and results of CT-guided percutaneous removal of osteoid osteoma (OO). Methods CT-guided percutaneous excision had undergone in eleven patients with OO,the diagnosis of OO was supported by the complete clinical and imaging files. The sites involved were the proximal parts of femor (7 cases),acetabulum ( 3 cases),humeral head (1 case). The procedure included the following steps: ① CT scanning included the whole nidus with thin slices of 1-3 mm, thickness /interval, and then selecting the center of nidus for the procedure. ② The guidewire needle was inserted through the bone directly to the nidus. ③ The trocar was introduced over through the guided needle and placed against the bone cortex. ④ The whole nidus was removed with trephine. ⑤ Complete lesion resection was checked with CT. Results The hospital stay was 7 days for all patients. Pain relief was rapidly (24 to 48 hours).In the follow-up of 3-12 months, mean 7.9 months, all the patients were pain free without severe complicationes. Among the 11 cases,10 had a final pathological diagnosis of OO. Conclusions Percutaneous removal of osteoid osteomas is safe and effective.