CAJ | 학술논문

目的：探讨计算机导航技术辅助经皮射频消融治疗骨样骨瘤手术方法和临床效果。方法回顾性分析2011年6月至2012年11月，我科应用计算机导航辅助经皮射频消融治疗骨样骨瘤13例的临床资料，其中男12例，女1例，平均16.5(8～36)岁。术前均经局部X线、CT、MRI明确诊断。肿瘤位于股骨干4例、股骨粗隆2例、股骨颈2例、股骨髁2例、胫骨干2例、跟骨1例。13例均采用Iso-C 3D C型臂术中实时导航，计算机软件均使用Stryker公司的脊柱导航软件。术中导航指引定位，骨活检针(9G )精确到达瘤巢，行穿刺活检，保留套筒，将射频针导入瘤巢，90℃消融6 min。术后进行随访，并采用疼痛视觉类比评分法( VAS )和术后X线、CT判断疗效。结果13例均获11.2(4～20)个月的随访。全部病例均完成计算机导航辅助下射频消融手术，11例组织病理学确诊为骨样骨瘤，2例组织学无法诊断，病理确诊率85%。术后疼痛即刻缓解，VAS评分显著降低。术前平均4.7，术后3天1.3，术后3个月为0.1，差异有统计学意义( P＜0.05)。全部病例随访未见肿瘤复发和疼痛复发。结论经皮射频消融治疗骨样骨瘤是一种简单、安全、有效的治疗方法。计算机导航技术的应用，使术中瘤巢定位更精确，使手术治疗的微创化成为现实。
목적：탐토계산궤도항기술보조경피사빈소융치료골양골류수술방법화림상효과。방법회고성분석2011년6월지2012년11월，아과응용계산궤도항보조경피사빈소융치료골양골류13례적림상자료，기중남12례，녀1례，평균16.5(8～36)세。술전균경국부X선、CT、MRI명학진단。종류위우고골간4례、고골조륭2례、고골경2례、고골과2례、경골간2례、근골1례。13례균채용Iso-C 3D C형비술중실시도항，계산궤연건균사용Stryker공사적척주도항연건。술중도항지인정위，골활검침(9G )정학도체류소，행천자활검，보류투통，장사빈침도입류소，90℃소융6 min。술후진행수방，병채용동통시각류비평분법( VAS )화술후X선、CT판단료효。결과13례균획11.2(4～20)개월적수방。전부병례균완성계산궤도항보조하사빈소융수술，11례조직병이학학진위골양골류，2례조직학무법진단，병리학진솔85%。술후동통즉각완해，VAS평분현저강저。술전평균4.7，술후3천1.3，술후3개월위0.1，차이유통계학의의( P＜0.05)。전부병례수방미견종류복발화동통복발。결론경피사빈소융치료골양골류시일충간단、안전、유효적치료방법。계산궤도항기술적응용，사술중류소정위경정학，사수술치료적미창화성위현실。
Objective To investigate the surgical method and clinical results of computer navigation-guided percutaneous radiofrequency ablation ( RFA ) in the treatment of osteoid osteomas. Methods From June 2011 to November 2012, 13 patients with osteoid osteomas were treated with computer navigation-guided percutaneous RFA, whose clinical data were retrospectively analyzed. There were 12 men and 1 woman with a mean age of 16.5 years old ( range;8-36 years ). Preoperatively all the diagnoses were conifrmed by the local X-ray, CT and MRI examinations. The femoral diaphysis was the most common site involved ( n=4 ), followed by the femoral trochanter ( n=2 ), the femoral neck ( n=2 ), the femoral condyle ( n=2 ), the tibial diaphysis ( n=2 ) and the calcaneus ( n=1 ). The intraoperative scanning with the C-arm Iso-C three-dimensional ( 3-D ) system ( Siemens ) was performed and the spine navigation system ( Stryker ) was used in all the cases. The core needle biopsy ( 9G ) which was guided by the navigation system was performed in the nidus, and the the outer sleeve was reserved as an access for the radiofrequency needle. The RFA was performed at 90℃for 6 minutes. All the patients were followed up postoperatively. The Visual Analogue Scale (VAS) was used before and after the surgery, and the X-ray and CT examinations were performed after the surgery to evaluate the results. Results All the 13 patients were followed up for 11.2 months on average ( range;4-20 months ), and they all underwent computer navigation-guided RFA successfully. Histopathological examination revealed 11 cases of osteoid osteomas and 2 cases of no diagnosis, and the pathological diagnosis rate was 85%. The postoperative pain got relieved instantly. The VAS scores were signiifcantly reduced, which were 4.7 points, 1.3 points and 0.1 points on average preoperatively and at 3 days and 3 months after the operation respectively, and the differences were statistically signiifcant ( P<0.05 ). Neither tumor recurrence nor pain relapse was found in all the patients during the follow-up. Conclusions Percutaneous RFA is a feasible, safe and effective method in the treatment of osteoid osteomas, with the advantages of more accurate positioning when inserting the needle in the nidus and minimally invasiveness under the guidance of computer navigation.