CT引导下经皮穿刺骨样骨瘤射频消融术

CT-guided radiofrequency ablation of osteoid osteoma in 42 patients

目的探讨CT引导下经皮穿刺骨样骨瘤射频消融术手术方法及临床疗效观察。方法2003年12月至2006年6月共治疗42例术前影像学诊断为骨样骨瘤的患者。男29例，女13例；年龄13-46岁，平均23．6岁；病程15d-2年，平均5个月。病灶部位：股骨近端15例，股骨远端2例，胫骨13例，骨盆7例，肱骨干2例，尺骨鹰嘴1例，跟骨1例，L4椎体1例。在腰麻或臂丛麻醉下行CT定位引导经皮穿刺射频消融术。术中CT扫描层厚为2-4mm，治疗温度90℃持续6min，用直径3．5-4mm穿刺针穿透骨皮质，将有效治疗直径1．5-2．0cm的射频电极准确插入瘤巢中心。随访18-24个月，平均19．5个月。手术前后行MR病灶扫描，进行影像学对比。疼痛视觉类比评分法（visual analoguescore，VAS）作为临床疗效评定参数。结果术后24h所有患者自主下地活动，术后3d-1周疼痛症状明显减轻，术后1个月随访疼痛基本消失。VAS评分明显降低，差异有统计学意义（P〈0．01）。术后37例病理结果证实为骨样骨瘤，其余5例因取材失败，病理结果为阴性。术中、术后无严重并发症，治疗成功率93％，末次随访无复发。术后复查MRT2加权像有不同程度信号降低。结论CT定位引导下经皮穿刺射频消融治疗骨样骨瘤是一种简单、微创、安全、高效的技术，射频消融电极针精确到达瘤巢是治疗成功的关键。

Objective To discuss and evaluate the clinical effectiveness of the treatment of osteoid osteoma by CT-guided percutaneous radiofrequency ablation （RFA）. Methods From December 2003 to June 2006, 42 patients with the diagnosis of osteoid osteoma were included in the study. There were 29 males and 13 females with an average age of 23.6 years （ranging from 13 to 46 years）. The history of the present illness was ranging from 15 d to 2 years, with an average of 5 months. There were 15 cases localized in the proximate femur, 2 cases in the distal femur, 13 cases in tibial, 7 cases in pelvis, 2 cases in humeral shaft, 1 case in olecranon, 1 case in calcaneus, 1 case in the fourth lumbar vertebra. After localization of the nidus with 2-4 mm CT sections, osseous access was established with a 3.5 to 4.0 mm coaxial drill system and a 1.5 to 2.0 cm active tip 15 G non-cooled radiofrequency needles. RFA was performed at 90℃ for a period of 6 minutes. All electrodes were inserted precisely into centre of the nidus. The follow-up period is 18 to 24 months. A comparison of preoperative and postoperative MRI scans was conducted. The pain visual analogue score （VAS） was used for clinical effectiveness. Results All procedures were technically successful. No major complications occurred. No recurrence was observed at the end of the follow-up period. All patients resumed unrestricted normal activity within 24 h. All patients gained significant pain release 3 d to one week and are pain-free one month after operation. Results at biopsy were positive in 37 patients. The primary success rate is 93%. Postoperative MRI T2-weighted signal reduction in different patients is varied. VAS decreased sharply, which is of significant statistical value （P〈 0.01） . Conclusion CT-guided RFA is a safe, simple and effective method of treatment for osteoid osteoma. That the RFA electrode needle was inserted into tumor nidus precisely is the key for effective treatment.