Cryoablation of osteoid osteomas:Is it a valid treatment option?

BACKGROUND Osteoid osteoma is a benign bone tumor with characteristic clinical symptomatology.The selected method for its treatment is percutaneous radiofrequency ablation.However,percutaneous cryoablation is an alternative method with certain advantages.AIM To evaluate percutaneous computed tomography(CT)-guided cryoablation for the treatment of osteoid osteoma in young patients and adults.METHODS A total of 25 patients were treated with percutaneous CT-guided cryoablation for osteoid osteomas between October 2020 and March 2023 at a single institution.All patients were above 14-years-old(mean age,24-years-old),and all procedures were performed under local anesthesia.Of the 25 patients,8 were female and 17 were male.Tumor sites included the femur(n=9),medial malleolus(n=4),sacral ala(n=4),facets(n=4),humerus(n=3),and tibia(n=1).One cryoprobe was used in each procedure and,when possible,the lesion was covered by the ice-ball using an extraosseous position without penetrating the nidus.All necessary thermal protective techniques were used depending on the anatomical structure at risk.RESULTS All patients treated had complete response(100%clinical success rate)starting on the day of the procedure.Technical success was achieved in all cases.Visual analog scale(VAS)scores at 1 year were 0,compared to a mean VAS score of 8.5±1(SD)before the procedure.No recurrences were reported at the 1-year follow-up and no complications were observed.In 11/25 cases,an extraosseous position of the cryoprobe was used with less procedural time achieving technical and clinical success and no complications with less patient discomfort.All patients were discharged from the hospital on the same day as the procedure.CONCLUSION Cryoablation of osteoid osteomas is an efficacious and safe procedure with durable clinical results.Its greatest advantage is that the procedure can be performed under local anesthesia using an extraosseous position of the cryoprobe when possible.

Osteoid Osteoma of the Second Metatarsal: An Exceptional Localization and Unusual Clinical Features

Osteoid osteoma of the foot can be difficult to diagnose, the clinical presentation may be mimicking other local pathologies leading to a considerable delay in diagnosis. We report an exceptional localization of osteoid osteoma in the second metatarsal in a 30-year-old patient, expressed for 3 years by metatarsalgia, with no clinical and radiological architecture defect of the foot. After discovering the nidus, the patient underwent surgical excision with an excellent outcome.

COMPARISON OF CT-GUIDED LESS INVASIVE SURGERIES WITH WIDE SURGICAL EXCISION IN TREATMENT OF OSTEOID OSTEOMAS

Objective To report the results of treatment of osteoid osteomas with wide surgical excision and CT-guided less invasive surgeries.Methods Forty-two patients were entered into this prospective study between Jan.1998 and Jan.2008.Nineteen patients underwent wide surgical excision.The lesions were in the femur(n=9),tibia(n=7),and humerus(n=3).The mean lesion diameter was(9.2±2.3)mm(range,7-16mm).Twenty-three patients(15 males and 8 females)underwent CT-guided less invasive surgeries procedures.The lesions were in the femur(n=9),tibia(n=6),acetabulum(n=4)and humerus(n=4).The mean lesion diameter was(8.1±2.7)mm(range,6-15mm).Among these 23 patients,20 patients were performed by core drill excision.Three patients were performed by radiofrequency ablation.Follow-up ranged from 16 to 68 months(mean,35 months)to assess pain,neurovascular damage,pathological fracture,movement,and recurrence.Results were categorized as success(persistent complete relief of pain)and failure(absent or incomplete relief of pain,requiring additional treatment).Results The success rates were 89%(17/19)after wide surgical excision and 96%(22/23)after less invasive surgeries,respectively,and the difference was not significant(P>0.05).Patients were hospitalized for average 8.3 d(5-15d)after wide surgical excision and 3.2d(3-5d)after less invasive surgeries(P<0.05).There were no complications such as sepsis,pathological fracture,or neurovascular damage.No further recurrences were observed during follow-up.Conclusion Less invasive surgeries has obvious advantages such as reduced cost,shorter stay in hospital and rapid convalescence.Core-drill excision can obtain sufficient material for pathologic examination.

CT-guided radiofrequency ablation of osteoid osteoma in the long bones of the lower extremity

AIM:To present our initial experience with computed tomography guided radiofrequency ablation(RFA) of osteoid osteoma(OO) in our institution.METHODS:RFA was performed on eight patients(5 males and 3 females) with clinically and radiologically diagnosed OO(femoral neck,n = 4;femoral diaphysis,n = 2;tibial diaphysis,n = 1;fibular diaphysis,n = 1).Ablation was performed using an electrode with a 10-mm exposed tip for a total of 4-6 min at a targeted temperature of 90 degrees Celsius.No cooling system was used.The intervention was accepted as technically successful if the tip of the electrode could be placed within the center of the nidus.We defined clinical success as a disappearance within 2 wk after treatment of symptoms that had manifested at presentation.RESULTS:All procedures were technically successful.No major or immediate complications were observed.Clinical success was achieved in six of eight patients in the first procedure.A second procedure was performed for two patients who had recurrent or continued pain,and one of these cases was successfully treated.The overall rate of success was 87.5%(7/8).No complication was observed.CONCLUSION:Our preliminary results indicate a favorable success rate and no complications and are compatible with the previous reports of RFA of OO.

Arthroscopic removal as an effective treatment option for intraarticular osteoid osteoma of the knee

BACKGROUND Intra-articular osteoid osteoma(iaOO)can be found in 5.2%up to 10%of cases.They may cause non-specific symptoms,mimicking degenerative or traumatic pathologies.If iaOO is left untreated,it may lead to severe muscle atrophy,tenderness,swelling,and limited range of motion.Therefore,surgical treatment is recommended.The main goal of surgical treatment is complete removal or destruction of iaOO.AIM To evaluate the efficiency of arthroscopic removal of iaOO of the knee in our cases and cases available in the literature.METHODS Analysis of available hospital records of four patients with iaOO of the knee treated by arthroscopic removal from August 2005 to December 2015 at our Department was performed.All patients had a diagnosis of iaOO confirmed by histopathologic analysis.Additional literature review of cases of iaOO of the knee available on PubMed and Google Scholar was made.All cases of iaOO of the knee treated by arthroscopic or arthroscopically assisted removal were reviewed in order to further evaluate the efficiency of the method.RESULTS The average age of patients included in our study was 23.2(range 16-37)years.The average duration of the symptoms prior to surgery was 14.2(range 6-24)months.All of the patients had persistent knee pain.Three patients reported worsening of pain during the night,while two reported worsening of pain during activity.Three patients reported alleviation of pain on non-steroidal anti-inflammatory drugs(NSAIDs),while one patient reported partial alleviation of pain on NSAIDs.No intraoperative complications were noted,and the postoperative period was uneventful in all patients.The patients reported immediate pain relief in the postoperative period.No recurrence of the disease was noted in any of the patients during the follow-up period of at least 24 mo.The literature review revealed 14 cases with an average age of 27.6(range 16-48)years and onset of symptoms 27.7(range 6-108)months prior to surgery,with recurrence of the disease noted in a single case.CONCLUSION Arthroscopic removal is an efficient treatment method that allows excision of iaOO that is neither insufficient nor excessive,thus avoiding disease recurrence while obtaining adequate material for histopathologic analysis.

Osteoid osteoma of the elbow mimicking hemophilic arthropathy

A case of osteoid osteoma of the elbow in a patient with hemophilia A is described. This male patient presented with chronic and nocturnal pain of the left elbow which was alleviated with acetaminophen. Besides pain, he also complained of stiffness. Before these complaints, he had recurrent bleedings in the elbow because of hemophilia. A delayed diagnosis of osteoid osteoma in the proximal part of the left ulna was established by a bone scan and a multislice spiral computed tomography(CT) scan. The lesion was surgically removed under CT-guidance. The histopathological analyses did not show specific features of osteoid osteoma. Two months after the operation, the complaints decreased and the range of motion of the left elbow improved. A diagnosis of osteoid osteoma of the elbow should be considered in young adult patients with persistent elbow pain and histological confirmation is not always necessary.

Osteoid Osteoma in the Lateral Malleolus, a Case Report

Osteoid osteoma is a benign bone tumor that is commonly seen in males in their second and third decade of life. The tumor commonly occurs in long bones (proximal femur and tibia) and rarely in the spine, hands and feet. It presents with bone pain worsening at night and responds well to nonsteroidal anti-inflammatory drugs. It is usually treated conservatively but sometimes with surgery if medical treatment fails. We present a case of 19-year-old girl, who presented with mild pain over lateral aspect of right ankle for 6 months duration. The pain was provoked by sporting activities, and was initially relieved by analgesics, until recently, hence her presentation. CT scan was done and showed a well-defined central nodule of bone. She had an open excisional biopsy, and the histology showed a diagnosis of osteoid osteoma. Post-operative healing was uneventful, the fracture united after 6 weeks and she was able to ambulate without any pain 3 months post-surgery.

Osteoid Osteoma of Proximal Phalanx of the Index Finger of the Right Hand

Osteoid osteoma is a benign bone forming tumor of the growing skeleton that is most often seen in young men. It represents by pain and radiologic appearance of anidus surrounded by osteosclerosisthat occurs mostly in long bones of the lower extremity. Occurrence of this tumor in the hand is an uncommon condition. We present a 23-year-old man with an osteoid osteoma in the proximal phalanx of the right index finger. The radiological examination showed a lytic lesion with irregular border with a central sclerotic nidus and also sclerotic changes around the lytic lesion and bone expansion in the proximal phalanx of the right index finger. He was suffering from a history of pain and swelling of his finger since 8 months. The pain disappeared after surgical excision of nidus. The patient was pain-free and there was no evidence of recurrence at 15 months follow up.

A New Technique to Remove Accurately Osteoid Osteomas Using Gamma Probe

Study design: Description of a technique through a case-series. Objective: To promote a technique by using a gamma probe that asses intraoperatively the adequacy of the lesion curettage through a minimal invasive procedure. Methods: Reviewing the technique steps through 4 cases of osteoid osteoma surgical removal. Results: Four patients diagnosed with osteoid osteoma and moved to surgical removal. During the operation, excision of the tumour was assessed by a gamma probe, avoiding leaving residual lesion in the field. Operating time was not prolonged, so as the cost of the operation was not increased. Conclusions: Surgical excision of osteoid osteoma in spine region is still the gold standard method. Avoiding recurrence of the lesion is important. The use of gamma probe is an effective and economic solution.

A Case Report of Oseoid Osteoma in the Ulnar Cortex of the Distarl Radius Extending into the Distal Radioulnal Joint<br>—COX-2 Produced Prostaglandin E2 Possible Case of the Symptoms<br>

An 18-year-old girl presented with an osteoid osteoma in the ulnar side of the cortex of the distal radius extending into the distal radioulnar joint. The osteoid osteoma was removed from the distal radius at surgery. The patient’s symptoms were dramatically improved the day after surgery. A high concentration of prostaglandin E2 (PGE2) was seen in the joint and surrounding soft tissues, and cyclooxygenase-2 (COX-2) receptors were stained in the joint capsule and synovium inside the joint. This case report is the first to describe the concentration of PGE2 and stained COX-2 receptors in an osteoid osteoma in the ulnar cortex of the distal radius extending into the distal radioulnar joint.

手术机器人引导经皮穿刺射频消融治疗骨样骨瘤

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。

机器人辅助与导航辅助治疗骨样骨瘤的回顾性队列研究

目的本研究旨在比较机器人辅助和导航辅助技术在骨样骨瘤治疗中的安全性和有效性,通过回顾性队列研究分析两种技术辅助下患者在手术时间、出血量、成功率、术后并发症及恢复情况等方面的差异。方法纳入2022年8月至2023年12月期间在首都医科大学附属北京积水潭医院接受机器人辅助或导航辅助治疗的64例骨样骨瘤患者(机器人辅助组,n=25;导航辅助组,n=39)。收集患者的年龄、性别、病灶部位、术前病灶大小、出血量、手术时间、随访时间、术前和出院前视觉模拟评分(Visual Analogue Score,VAS)、成功率等数据,进行描述性统计分析和比较分析。结果两组患者在年龄、性别、病灶部位、术前病灶大小、术前VAS评分和随访时间上差异无统计学意义。机器人辅助组的手术时间显著短于导航辅助组[(102.64±21.65)min vs(120.46±30.98)min,P=0.025]。机器人辅助组与导航辅助组出血量分别为[50(20,50)mL vs 50(20,100)mL],但两组间差异无统计学意义(P=0.287)。两组在出院前VAS评分变化上差异无统计学意义(P>0.05)。两组治疗成功率均为100%。结论机器人辅助手术在骨样骨瘤治疗中具有显著的优势,尤其在手术时间和手术精度方面表现优越。未来的研究应进一步探索这两种技术的长期效果和经济性,以为临床实践提供更全面的指导。

Subtrochanteric osteoid osteoma： A misdiagnosed case complicated by a hip fracture

A 34-year-old man with a subtrochanteric osteoid osteoma localized to the lateral cortex of the left femur is reported. The patient presented with mild spontaneous pain of the lateral thigh and knee. He refused a radiographic examination and was treated as a greater trochanteric pa in syndrome for 9 months. He was then admitted with a transcervical fracture of the neck of the left femur after a fall from standing height. The fracture was fixed with 3 cannulated screws and healed uneventfully. His symptoms worsened after the first postoperative year. Eighteen months postoperatively the pain was dull, worsening at night, and relieved only with anti-inflammatory drugs, and he had a limp. New radiographs and tomograms were indicative of a lateral subtrochanteric osteoid osteoma with a subperiosteal localization. The lesion was treated successfully with surgical excision of a piece of reactive bone including the nidus.

长骨皮质型骨样骨瘤的影像学表现与鉴别诊断

目的探讨长骨皮质型骨样骨瘤的影像学表现及其与骨母细胞瘤、迁延性灶性坏死性疲劳骨折及慢性皮质型骨髓炎的鉴别诊断。方法选取临床随诊或病理学证实的33例长骨皮质型骨样骨瘤患者的影像学资料,其中行X线平片检查18例,行CT检查26例,行MRI检查10例,其中增强MRI扫描2例。由2位资深影像科医师分别阅片。结果X线平片检查显示瘤巢14例、中央区钙化6例;CT检查显示瘤巢25例、中央区钙化22例;MRI检查显示瘤巢10例、中央区钙化8例。瘤巢呈圆形5个、卵圆形21个、枣核状7个。皮质“实性”增厚者8例,“皮质软化”性增厚者25例,3例皮质呈双翼征增厚,增厚的皮质或(和)骨质硬化区内出现“血管沟征”22例。结论长骨皮质型骨样骨瘤瘤巢多呈平行于骨干长轴的卵圆形或枣核状,瘤巢周围伴有特征性的皮质增厚、髓腔内反应性骨硬化、骨髓与软组织水肿,“皮质软化”征与“血管沟”征是长骨皮质型骨样骨瘤重要的影像学征象。

髋关节骨样骨瘤诊断与关节镜治疗效果分析

目的:探讨髋关节骨样骨瘤的诊断及关节镜治疗的方法和疗效。方法:回顾2010年4月至2013年4月在我院收治的髋关节骨样骨瘤患者共8例,其中男性6例、女性2例;平均年龄(26.5±15.7)岁;左、右髋各4例。患者均表现为髋部疼痛并伴有关节功能受限,7例夜间疼痛加剧,6例口服非甾体类抗炎药(NSAIDs)能完全或部分缓解。肿瘤均为单发,7例位于股骨颈,1例位于髋臼窝。术前均通过CT检查确诊和定位,手术主要采用关节镜下完整切除病灶。术前和术后采用VAS疼痛评分及改良髋关节Harris评分评估治疗效果,同时评估患者术后24小时夜间疼痛加剧情况和最终满意度。结果:8例患者从发病到手术时间为2个月到36个月,平均(17.8±12.3)个月,术前均通过薄层CT+三维重建影像发现瘤巢,术后病理诊断均为骨样骨瘤。8例患者平均随访时间(18.6±16.0)个月。术后24小时夜间疼痛加剧均消失,VAS疼痛评分由术前(7.3±1.4)分降到(1.1±0.8)分,P<0.01;最终随访髋关节功能活动在(4.1±2.0)周恢复正常,改良髋关节Harris评分由术前(52.1±6.3)提高到(92.3±4.3),P<0.01,8例患者均无复发,满意度均为优(100%)。结论:髋关节骨样骨瘤由于其临床表现和X线片影像不典型,容易漏诊,CT有助于确诊和术前定位。手术治疗关键在于准确定位并完整切除瘤巢,关节镜下切除肿瘤可以有效消除疼痛,及早恢复关节功能,微创、安全、效果满意。

关节内骨样骨瘤的影像学表现特点

目的:分析关节内骨样骨瘤的临床及影像学表现特点。方法:回顾性分析了17例手术病理证实的关节内骨样骨瘤临床、X线、CT及MR的表现特点。结果:髋关节13例,膝关节1例,肘关节1例,肩关节1例,椎间关节1例。5例具有典型的夜间疼痛加重。17例中X线显示瘤巢6例,周围骨质硬化7例,关节肿胀9例。CT显示瘤巢17例,周围骨质硬化12例,关节肿胀11例。14例行MR检查,显示瘤巢6例,关节肿胀11例。结论:关节内骨样骨瘤以髋关节好发,其临床表现常不典型。难以显示瘤巢而关节积液明显是X线和MR误诊、漏诊的原因。CT能最好地显示瘤巢,是能获得准确诊断的主要因素。

鼻窦骨化纤维瘤手术探讨

目的 探讨鼻窦骨化纤维瘤的手术进路 ,分析各种手术的方法和特点。方法 回顾性分析我院 1994年 8月～ 2 0 0 1年 7月治疗的鼻窦骨化纤维瘤 35例的临床资料。结果 35例中男 2 3例 ,女 12例 ,年龄 2～ 4 5岁 ,平均 17 1岁。手术方式包括鼻侧切开手术、鼻内镜下手术、冠状切口颅骨切开手术 (包括冠状切口颅骨切开联合鼻内镜下手术及冠状切口颅骨切开联合鼻侧切开手术 )、Caldwell Luc进路手术。鼻内镜下手术 2 2例 ,彻底切除 8例 ,部分切除 14例。 2例在影像导航辅助下手术。鼻侧切开手术 6例 ,彻底切除 4例 ,部分切除 2例。冠状切口颅骨切开手术 5例 ,彻底切除 2例 ,部分切除 3例 ,有 2例联合鼻内镜下手术 ,1例联合鼻侧切开手术。Caldwell Luc进路手术 2例 ,均为部分切除。 35例患者随访 33例 ,失访 2例 ,平均随访时间 3 5年。结果 14例无复发 ,14例带瘤生存 ,5例复发后再次手术。结论 鼻窦骨化纤维瘤手术进路的选择主要依据病变范围 ,同时要考虑器官结构的功能、美容、手术的难易程度以及术者的经验和习惯等。

骨样骨瘤的诊断与治疗

目的:研究骨样骨瘤的临床特点以及外科治疗效果,提高诊治水平。方法:回顾性分析1997年1月至2009年10月确诊的35例骨样骨瘤的临床资料,其中男25例,女10例,平均发病年龄21岁(6～49岁)。最常见的部位为胫骨(13例)和股骨(7例)。发病至确诊时间平均为12个月(1～24个月),典型的症状为疼痛,夜间加重,服用非甾体抗炎药可缓解,影像学表现为一圆形或卵圆形的瘤巢。所有患者均经手术治疗:单纯肿瘤切除9例,肿瘤刮除或切除人工骨或自体骨植骨19例,肿瘤刮除或切除植骨固定7例。结果:术后平均随访49个月(2个月～12年),所有患者疼痛症状均消失,未见病灶复发。1例术后4个月出现胫骨病理性骨折,经钢板螺钉内固定后治愈。1例术后5年窦道形成,行窦道切除、髓内钉取出、清创术后治愈。结论:根据典型临床表现、影像学特点,骨样骨瘤的诊断并不困难,为缓解症状、提高生活质量、预防远期并发症,确诊后应尽早手术治疗。

CT引导下经皮穿刺切除骨样骨瘤

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。

以脊柱侧凸为首诊的脊柱骨样骨瘤:鉴别诊断与治疗

[目的]探讨脊柱骨样骨瘤伴脊柱侧凸的诊断及治疗方式的选择,并分析其治疗转归及疗效。[方法]回顾研究1997年2月～2006年12月收治脊柱骨样骨瘤9例,年龄8～21岁(平均15.2岁),其中胸段2例,胸腰段2例,腰段5例。所有病人均以脊柱侧凸为首诊,同时伴有脊柱区疼痛,Cobb’s角为10°～30°(平均22°)。1例因侧凸度数较大为30°,躯干倾斜明显,而当即行瘤巢切除术,1例8岁患者,因躯干倾斜明显,在CT证实后行手术切除。1例诊断不明者亦一期进行了手术治疗。6例病人接受了试验性口服阿斯匹林和非甾体类消炎镇痛药治疗,1个月后疼痛均明显缓解,其中3例轻度脊柱侧凸无明显进展,继续服用阿斯匹林和非甾体类消炎镇痛药后疼痛完全消失,停药后无复发,未予手术。另3例停止服药疼痛症状复发,予以手术切除瘤巢。[结果]所有手术患者术后均病理证实为骨样骨瘤。手术患者术后疼痛症状缓解;脊柱侧凸患者中5例侧凸消失或度数小于15°,4例侧凸成为结构性,在支具控制下,侧凸度数减轻。[结论]青少年腰背痛或者疼痛性脊柱侧凸需考虑脊柱骨样骨瘤的可能。薄层CT横扫是最有效和最有助于定位的方法。脊椎骨样骨瘤病人可先行药物治疗,严格随访,如有需要,再行手术切除。