"O"型臂导航下小切口磨钻刮除治疗骨样骨瘤

Mini-open excision of osteoid osteoma using burrs with the guidance of O-arm navigation

目的探讨"O"型臂导航下小切口磨钻刮除治疗骨样骨瘤的手术方法和临床疗效。方法收集2021年6月至2022年5月采用"O"型臂导航下磨钻刮除治疗的骨样骨瘤患者18例,男15例、女3例;年龄(18.4±10.9)岁(范围2~44岁);病程1周~3年,平均14.2个月。病灶部位:股骨近端6例,股骨远端3例,胫骨近端4例,胫骨远端1例,腓骨近端2例,肱骨远近端各1例。术中应用"O"型臂导航确定病灶部位,通过1~4 cm小切口剥离肌肉软组织至骨面,放置通道拉钩,将磨钻注册为导航识别设备,逐步磨除瘤巢表面骨质,以刮匙刮除瘤巢送病理学检查;根据导航图像用磨钻扩大磨除病灶,结束前再次"O"型臂X射线机扫描确认磨除范围。随访6~15个月,平均9.5个月。手术前后行CT病灶扫描,进行影像学对比病灶是否有残留或复发。疼痛视觉模拟评分法(visual analogue score,VAS)作为临床疗效评定参数。结果18例手术时间40~175 min,平均89.3 min,其中建立导航图像所需时间为(18.0±4.1)min(范围13~22 min)。手术切口长为(2.7±1.1)cm(范围1~4 cm)。所有患者均达到病灶完全刮除,术后病理全部证实为骨样骨瘤。全部病例随访6~15个月,平均9.5个月。术后24 h患者均自主下地活动,术后第3至7天疼痛性质和症状明显减轻,术后3个月疼痛基本消失。18例术前VAS为(5.33±1.24)分,术后第3天为(2.79±1.32)分,术后第7天为(1.86±1.21)分,术后1个月为(0.86±0.93)分,术后3个月为(0.33±0.48)分,术后6个月为(0.09±0.29)分,差异有统计学意义(F=58.50,P<0.001)。术中及术后无严重并发症,治疗成功率(症状缓解无复发,影像学病灶无残余无复发,术后无严重并发症)为100%。结论"O"型臂导航下小切口磨钻刮除治疗骨样骨瘤是一种简单、安全、微创而高效的技术手段,术中精确定位及磨除范围大于瘤巢是治疗成功的关键。

Objective To investigate the surgical method and clinical effect of O-arm navigation mini-open burring for osteoid osteoma.Methods Eighteen patients with osteoid osteoma were treated with O-arm guided grinding drill from June 2021 to May 2022,including 15 males and 3 females,the age was(18.4±10.9)years(range 2 to 44 years),and the course of disease ranged from 1 week to 3 years(mean 14.2 months).The lesions sites included 6 cases of proximal femur,3 cases of distal femur,4 cases of proximal tibia,1 case of distal tibia,2 cases of proximal fibula and 1 case of distal and proximal humerus.During the operation,the O-arm navigation was used to determine the location of the focus,the muscle and soft tissue was peeled off to the bone surface through a 1-4 cm small incision,the channel retractor was placed,and the burr was registered as a navigation recognition device to gradually remove the bone on the surface of the tumor nest,and the tumor nest was scraped with a curette for pathological examination;according to the navigation image,the focus was enlarged removed with burr and the grinding range was confirmed by the O-arm X-ray machine before the end of the operation.The patients were followed up for 6 to 15 months(mean 9.5 months).CT scans were performed before and after surgery for imaging comparison in order to figure out whether it had residual lesions or recurrence.The visual analogue score(VAS)of pain was used as a parameter for evaluating the clinical efficacy.Results The operation time of 18 cases was 40-175 min,with an average of 89.3 min.The time required to establish navigation image was 18.0±4.1 min(range 13~22 min).The length of the incision was 2.7±1.1 cm(range 1-4 cm).All patients achieved complete curettage of the lesions,and osteoid osteoma was confirmed by pathology after operation.All the patients could move to the ground 24 hours after operation,and the pain was significantly relieved from 3 to 7 d after operation,and the pain almost disappeared 3 months after operation.The VAS score of 18 cases was 5.33±1.24 before surgery,2.79±1.32 on the 3rd day,1.86±1.21 on the 7th day,0.86±0.93 on the 1st month,0.33±0.48 on the 3rd month,and 0.09±0.29 on the 6th month after operation,and the difference was statistically significant(F=58.50,P<0.001).There were no serious complications during and after operation,and the success rate of treatment(no recurrence of symptoms,no residual recurrence of imaging lesions,no serious complications after operation)was 100%.Conclusion Treatment of osteoid osteoma with mini-open excision using burrs under the navigation of O-arm is a simple,safe,minimally invasive and efficient technique.Intraoperative precise positioning and the use of burr with navigation to remove a larger area than the tumor nest are the keys to successful treatment.