目的 观察和分析经皮射频消融(RFA)对活体猪胫骨的损毁情况,对损毁灶周围组织结构的影响以及RFA后骨的修复过程,为骨肿瘤的临床RFA治疗提供参考.方法 第1部分实验:活猪8头,麻醉状态下,分别于右侧后腿胫骨骨端、骨干的相同位置行RFA.RFA后依照实验方案设定时间于麻醉下行X线及CT检查后,在下列不同时间,深度麻醉下分别处死实验猪1头,获取空白对照及RFA后即刻、3d、10d、24 d、5周、8周、12周骨端、骨干标本各1个.标本经肉眼观察及测量后,送病理室做骨切片(HE染色)镜下观察.实验观察指标:RFA对实验猪一般状态的影响;大体标本RFA灶的形态与病理切片光镜下对应的组织学改变,RFA后RFA灶的影像改变与其对应的组织改变;光镜下RFA灶的坏死边界及与其对应的大体标本的坏死边界.第2部分实验:活猪16头,于左、右侧后腿胫骨骨端、骨干的相同位置行RFA,RFA后立即深度麻醉处死实验猪,获取骨端及骨干标本各32个,沿RFA针针道纵向剖开RFA灶,力求获得RFA灶最大剖面,肉眼观察并测量大体标本长短径.实验观察指标:RFA灶的坏死边界及坏死范围,实验测量指标包括RFA灶的长径、短径及坏死体积.骨端、骨干RFA灶坏死体积采用独立样本t检验进行分析,骨端、骨干RFA灶坏死体积2组数据与射频消融仪标定的坏死体积采用单样本t检验进行分析.结果 第1部分实验:RFA实验及术后饲养过程中未出现实验猪意外死亡,未观察到实验猪后腿神经功能受损的表现.活体猪骨端松质骨及骨干骨髓RFA灶均呈凝固性坏死.RFA灶边缘的出血带内于RFA后3～10d即可出现炎性细胞浸润、肉芽组织形成,并向内逐渐吸收坏死骨质.第10天X线及CT检查表现为低密度骨质吸收线或带,继而向内延伸;第24天在肉芽组织成熟形成的纤维组织内即可观察到未成熟新骨形成,X线及CT检查表现为低密度骨质吸收带外缘的骨质硬化.实验观察显示RFA灶的坏死范围包括大体标本所示凝固性坏死区及周围出血带.X线、CT检查及大体标本均观察到2头猪胫骨骨干出现死骨形成及病理性骨折.RFA对活体猪骨干密质骨的直接损毁作用甚微,完整骨皮质外的软组织未见损伤.第2部分实验:骨端松质骨RFA灶坏死区为椭球体,长轴(2.59±0.21) cm,短轴(2.15±0.10) cm,体积(6.34±0.27) cm3;骨干髓腔RFA灶为椭球体,长轴(4.53±0.20) cm,短轴(1.71±0.22) cm,体积(7.14±0.36) cm3.骨干RFA灶坏死体积大于骨端,差异有统计学意义(t=2.011,P＜0.05);骨端、骨干与射频消融仪标定RFA灶坏死体积(113.04 cm3)对比,差异均有统计学意义(t值分别为-613.371,-295.878,P值均＜0.01),前者小于后者.结论 RFA能够损毁骨端松质骨,对骨干骨皮质损毁有限,完整的骨皮质可以保护其外的软组织结构.X线及CT检查可以用来评估RFA灶坏死范围.RFA后应警惕病理性骨折可能.
目的 觀察和分析經皮射頻消融(RFA)對活體豬脛骨的損燬情況,對損燬竈週圍組織結構的影響以及RFA後骨的脩複過程,為骨腫瘤的臨床RFA治療提供參攷.方法 第1部分實驗:活豬8頭,痳醉狀態下,分彆于右側後腿脛骨骨耑、骨榦的相同位置行RFA.RFA後依照實驗方案設定時間于痳醉下行X線及CT檢查後,在下列不同時間,深度痳醉下分彆處死實驗豬1頭,穫取空白對照及RFA後即刻、3d、10d、24 d、5週、8週、12週骨耑、骨榦標本各1箇.標本經肉眼觀察及測量後,送病理室做骨切片(HE染色)鏡下觀察.實驗觀察指標:RFA對實驗豬一般狀態的影響;大體標本RFA竈的形態與病理切片光鏡下對應的組織學改變,RFA後RFA竈的影像改變與其對應的組織改變;光鏡下RFA竈的壞死邊界及與其對應的大體標本的壞死邊界.第2部分實驗:活豬16頭,于左、右側後腿脛骨骨耑、骨榦的相同位置行RFA,RFA後立即深度痳醉處死實驗豬,穫取骨耑及骨榦標本各32箇,沿RFA針針道縱嚮剖開RFA竈,力求穫得RFA竈最大剖麵,肉眼觀察併測量大體標本長短徑.實驗觀察指標:RFA竈的壞死邊界及壞死範圍,實驗測量指標包括RFA竈的長徑、短徑及壞死體積.骨耑、骨榦RFA竈壞死體積採用獨立樣本t檢驗進行分析,骨耑、骨榦RFA竈壞死體積2組數據與射頻消融儀標定的壞死體積採用單樣本t檢驗進行分析.結果 第1部分實驗:RFA實驗及術後飼養過程中未齣現實驗豬意外死亡,未觀察到實驗豬後腿神經功能受損的錶現.活體豬骨耑鬆質骨及骨榦骨髓RFA竈均呈凝固性壞死.RFA竈邊緣的齣血帶內于RFA後3～10d即可齣現炎性細胞浸潤、肉芽組織形成,併嚮內逐漸吸收壞死骨質.第10天X線及CT檢查錶現為低密度骨質吸收線或帶,繼而嚮內延伸;第24天在肉芽組織成熟形成的纖維組織內即可觀察到未成熟新骨形成,X線及CT檢查錶現為低密度骨質吸收帶外緣的骨質硬化.實驗觀察顯示RFA竈的壞死範圍包括大體標本所示凝固性壞死區及週圍齣血帶.X線、CT檢查及大體標本均觀察到2頭豬脛骨骨榦齣現死骨形成及病理性骨摺.RFA對活體豬骨榦密質骨的直接損燬作用甚微,完整骨皮質外的軟組織未見損傷.第2部分實驗:骨耑鬆質骨RFA竈壞死區為橢毬體,長軸(2.59±0.21) cm,短軸(2.15±0.10) cm,體積(6.34±0.27) cm3;骨榦髓腔RFA竈為橢毬體,長軸(4.53±0.20) cm,短軸(1.71±0.22) cm,體積(7.14±0.36) cm3.骨榦RFA竈壞死體積大于骨耑,差異有統計學意義(t=2.011,P＜0.05);骨耑、骨榦與射頻消融儀標定RFA竈壞死體積(113.04 cm3)對比,差異均有統計學意義(t值分彆為-613.371,-295.878,P值均＜0.01),前者小于後者.結論 RFA能夠損燬骨耑鬆質骨,對骨榦骨皮質損燬有限,完整的骨皮質可以保護其外的軟組織結構.X線及CT檢查可以用來評估RFA竈壞死範圍.RFA後應警惕病理性骨摺可能.
목적 관찰화분석경피사빈소융(RFA)대활체저경골적손훼정황,대손훼조주위조직결구적영향이급RFA후골적수복과정,위골종류적림상RFA치료제공삼고.방법 제1부분실험:활저8두,마취상태하,분별우우측후퇴경골골단、골간적상동위치행RFA.RFA후의조실험방안설정시간우마취하행X선급CT검사후,재하렬불동시간,심도마취하분별처사실험저1두,획취공백대조급RFA후즉각、3d、10d、24 d、5주、8주、12주골단、골간표본각1개.표본경육안관찰급측량후,송병리실주골절편(HE염색)경하관찰.실험관찰지표:RFA대실험저일반상태적영향;대체표본RFA조적형태여병리절편광경하대응적조직학개변,RFA후RFA조적영상개변여기대응적조직개변;광경하RFA조적배사변계급여기대응적대체표본적배사변계.제2부분실험:활저16두,우좌、우측후퇴경골골단、골간적상동위치행RFA,RFA후립즉심도마취처사실험저,획취골단급골간표본각32개,연RFA침침도종향부개RFA조,력구획득RFA조최대부면,육안관찰병측량대체표본장단경.실험관찰지표:RFA조적배사변계급배사범위,실험측량지표포괄RFA조적장경、단경급배사체적.골단、골간RFA조배사체적채용독립양본t검험진행분석,골단、골간RFA조배사체적2조수거여사빈소융의표정적배사체적채용단양본t검험진행분석.결과 제1부분실험:RFA실험급술후사양과정중미출현실험저의외사망,미관찰도실험저후퇴신경공능수손적표현.활체저골단송질골급골간골수RFA조균정응고성배사.RFA조변연적출혈대내우RFA후3～10d즉가출현염성세포침윤、육아조직형성,병향내축점흡수배사골질.제10천X선급CT검사표현위저밀도골질흡수선혹대,계이향내연신;제24천재육아조직성숙형성적섬유조직내즉가관찰도미성숙신골형성,X선급CT검사표현위저밀도골질흡수대외연적골질경화.실험관찰현시RFA조적배사범위포괄대체표본소시응고성배사구급주위출혈대.X선、CT검사급대체표본균관찰도2두저경골골간출현사골형성급병이성골절.RFA대활체저골간밀질골적직접손훼작용심미,완정골피질외적연조직미견손상.제2부분실험:골단송질골RFA조배사구위타구체,장축(2.59±0.21) cm,단축(2.15±0.10) cm,체적(6.34±0.27) cm3;골간수강RFA조위타구체,장축(4.53±0.20) cm,단축(1.71±0.22) cm,체적(7.14±0.36) cm3.골간RFA조배사체적대우골단,차이유통계학의의(t=2.011,P＜0.05);골단、골간여사빈소융의표정RFA조배사체적(113.04 cm3)대비,차이균유통계학의의(t치분별위-613.371,-295.878,P치균＜0.01),전자소우후자.결론 RFA능구손훼골단송질골,대골간골피질손훼유한,완정적골피질가이보호기외적연조직결구.X선급CT검사가이용래평고RFA조배사범위.RFA후응경척병이성골절가능.
Objective To observe destruction of tibias created in ablating of the swine limbs in vivo with radiofrequency,the influence on the surrounding organization structure,and the repair process of lesions for treating bony tumor.Methods There were eight pigs included in the first part of the experiment.RFA was performed under DSA guidance at the same position of the diaphysis and the upper end of their right tibias in hind leg during anesthesia,then X-ray and CT examinations were performed at different time points after RFA,and subsequently the pigs were executed by depth anesthesia.Control specimens,specimens of the immediate time,the third day,the tenth day,the twenty-fourth day,the fifth week,the eighth week,the twelfth week after RFA were obtained at the diaphysis and the upper end of their tibias.X-ray and CT examinations of these specimens were performed.These specimens were observed both by naked eye and under microscope.The observation included the general state of the laboratory animals after RFA,the configuration of RFA lesions in the gross specimen and the corresponding histologic changes,the boundary of necrosis in RFA lesions and the corresponding boundary of the gross specimen.There were sixteen pigs in the second part of the experiment.RFA was performed at the same position of the diaphysis and the upper end of their right and left tibias in hind leg during anesthesia,and the pigs were immediately executed by depth anesthesia after RFA to get thirty-two capitulum specimens and thirty-two diaphysis specimens.The scope of necrotic tissue in RFA lesions was observed and measured.The border and scope of necrotic tissue in RFA lesions were observed.Major axis,minor axis,and necrosis volume were measured.The independent sample t test was employed to compare the volume of necrotic tissues between capitulum and diaphysis.The one sample t test was employed to analyze volume of necrotic tissue among capitulum,diaphysis and the standard data.Results No accidental death of the animals occured in the first experimental.The loss of neurological function of the hind leg did not happen.Coagulation necrosis in cancellous bone of capitulum and marrow of diaphysis lesions created in ablating was observed.On 3th to 10th day after RFA,inflammatory cells infiltrated in hemorrhage tape and then granulation tissues formed.Granulation tissues replaced necrotic bone gradually from outside to inside.Low density band was showed on images of X-ray and CT examination in the specimen of 10th day,and it extended inward.The immature bone was observed in fibrous tissue sited at the edge of lesions,which appeared as sclerosis on X-ray and CT examination.The scope of necrotic tissue in RFA lesions included coagulation necrosis and hemorrhagic zone of its periphery.The dead bone and secondary pathological fracture appeared in two of eight pigs.RFA hardly damaged compact bone in the diaphysis,but the damage of soft tissue was observed outside the compact bone.In the second experiment,the shape of lesions in cancellous bone of capitulum was ellipsoid,with long axis of(2.59±0.21) cm,minor axis of(2.15±0.10) cm,and volume of(6.34±0.27) cm3.The shape of lesions in the diaphysis of tibias was ellipsoid,with long axis of(4.53±0.20) cm,minor axis of(1.71 ±0.22) cm,and volume of(7.14±0.36) cm3.There was significantly difference of necrosis volume between the capitulum and diaphysis lesions,(t=2.011,P＜0.05).The virtual necrosis volume of the capitulum and diaphysis lesions was significantly different from the presumed volume with RFA instrument(t=-613.371,-295.878,P＜0.01).Conclusion Cancellous bone of the capitulum can be damaged by RFA,but the compact bone of the diaphysis can hardly be damaged.The intact compact bone can be helpful to protect the surrounding soft tissues.X-ray and CT examination can be used in the evaluation of curative effect of RFA for treating bone tumors.Pathological fracture of the diaphysis may appear after RFA.
