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.

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.

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.

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.

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。

Osteoid osteoma of the patella： report of two cases

Osteoid osteoma is very rarely located in the patella, and can represent a significant diagnostic challenge, resulting in a delay of treatment. Patients with osteoid osteoma of the patella often present with knee pain that is also a typical symptom of trauma or of other diseases such as arthritis, which are much more common than osteoid osteoma. We present two young male patients diagnosed with osteoid osteoma of the patella. Each of these patients had a history of intense knee pain; however, accurate diagnosis of osteoid osteoma in the patella had been delayed for more than one year. Computed tomography （CT） scans or magnetic resonance imaging （MRI） showed a circumscribed lesion of the patella in both patients, whereas X-ray examination （posteroantedor projection） was not able to detect the tumor. Different surgical procedures were performed in these patients for resection of the tumors, and the pathology findings confirmed the diagnosis of osteoid osteoma. Both patients recovered completely from surgery.

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.

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。

CT-guided percutaneous radiofrequency ablation of spinal osteoid osteoma

Background This study evaluated the feasibility, efficacy and safety of CT-guided percutaneous radiofrequency ablation in patients with spinal osteoid osteoma. Methods Two patients suffered spinal osteoid osteoma were treated with CT-guided percutaneous radiofrequency ablation under local anesthesia. Lesions located in sacral vertebrae and cervical vertebrae, which were adjacent to nerve root and spinal canal respectively. Tumors were treated under 90℃ radiofrequency temperature lasting 4 minutes by an electrode placement. Visual analog scale was used to evaluate the pain improvement. Results No complications were observed pre- and post-operation. Patients recovered to normal activities immediately and achieved complete pain relief in 24 hours. No symptoms were recurrent in 5 months and 4 months follow up. Mild scoliosis has been recovered in case 2. Conclusions CT-guided percutaneous radiofrequency ablation of spinal osteoid osteoma is safe, effective and has more clinical benefits. The long-term outcome needs further observation.

射频消融和开放手术治疗儿童股骨骨样骨瘤的临床效果

目的回顾性分析射频消融和开放手术治疗儿童股骨骨样骨瘤的临床效果。方法选择2010-04至2023-02首都医科大学附属北京儿童医院骨科收治的股骨骨样骨瘤(术后病理证实)患者24例,其中射频消融组11例(男8例,女3例),开放手术组13例(男9例,女4例),收集患者临床资料包括年龄,性别,随访时间,术前,术后3 d和末次随访疼痛评分,手术时长,住院时长,出血量,术中CT扫描次数;影像资料包括术前瘤体直径及末次随访有无复发灶。对比治疗效果。结果射频消融组和开放手术组患者手术出血量分别为(1.73±1.19)ml和(12.31±5.99)ml,住院时长分别为(8.27±1.27)d和(12.23±1.88)d,术中CT扫描次数分别为(1.64±0.81)次和(0.31±0.48)次,术后3 d VAS评分分别为(1.73±0.65)和(3.62±0.87),上述差异均有统计学意义(P<0.05)。射频消融组有1例发生轻度热损伤,开放手术组有1例术后复发。结论与开放手术相比,射频消融治疗儿童股骨骨样骨瘤有出血少、住院时间短,疼痛症状缓解快等优点,值得推广,但应注意避免热损伤的发生。

儿童亚急性骨髓炎误诊原因分析

目的 探讨儿童亚急性骨髓炎的误诊原因及防范措施。方法 回顾性分析2018年1月—2022年1月收治的儿童亚急性骨髓炎误诊3例的临床资料。结果 3例均因患侧下肢肿痛、发热初诊,其中1例夜间疼痛明显。3例血白细胞计数均正常,2例C反应蛋白增高。3例均行X线检查,2例患侧股骨或胫腓骨大段骨膜反应,1例患足第5跖骨近端干骺端见类圆形低密度灶。误诊为骨囊肿2例,骨样骨瘤1例。误诊时间6~10 d。确诊后均行病灶刮除、植骨手术治疗,术后病理检查确诊为亚急性骨髓炎,给予抗生素治疗,其中1例出现手术切口化脓感染,予以换药治疗。3例病情好转后出院,随访1年预后良好。结论 儿童亚急性骨髓炎缺乏特异性临床表现,影像学表现难以与部分骨肿瘤鉴别,掌握该病临床特点、必要时行病变组织病理检查,可减少或避免误诊误治。

短骨骨样骨瘤的影像诊断

目的探讨短骨骨样骨瘤的影像学特征,旨在减少该病的漏诊和误诊。方法选取9例短骨骨样骨瘤的影像学资料,所有病例均经手术病理证实。其中7例行X线摄影(DR)检查,1例行数字化体层摄影检查,7例行CT检查,4例行MRI检查。结果9例短骨骨样骨瘤的瘤巢直径3~9 mm,周围软组织可见明显梭形肿胀。DR和CT检查表现为类圆形低密度瘤巢,周围可见骨质硬化和骨皮质增厚。瘤巢内可出现高密度钙化或骨化,与周围的骨质硬化区间隔以环形透亮区,为本病的特征性表现。压脂T_(2)WI序列可清楚显示瘤巢周围软组织及骨髓水肿。结论短骨骨样骨瘤较为少见,且临床和影像学表现软组织肿胀,因而影像诊断常较为困难,准确识别瘤巢是诊断短骨骨样骨瘤的关键。

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。

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。

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。