Gallazzi M B, Arborio G, Garbagna P G, Perrucchini G, Daolio P A
Servizio di Radiologia, Azienda Ospedaliera Istituto Ortopedico Gaetano Pini, Milan, Italy.
Radiol Med. 2001 Nov-Dec;102(5-6):329-34.
To report our personal experience with the percutaneous technique for in situ destruction of osteoid osteoma using radio-frequency ablation.
From January 2000 to January 2001 we performed 16 radio-frequency ablations in 15 patients. All candidates for treatment had previously undergone clinical and radiologic examinations to confirm features typical of osteoid osteoma. After administration of spinal anesthetic, procedures were performed with CT-guidance, using a Kirschner wire introduced into the localized lesion, and a guiding cannula. A hole was first cut into the bone with a cutter, then a few biopsy specimens were obtained with a Jamshidi needle. Finally, we introduced a small radio-frequency electrode into the bone, through the biopsy track. Sufficient current was used to heat the electrode tip to 85-90 degrees C with consequent thermal necrosis of the tissue. The healing was continued for 6 minutes.
All patients well tolerated the percutaneous procedure and only 1 underwent a second, successful radio-frequency ablation. In all cases, pain relief was noted to occur very rapidly and all patients could bear full weight on the treated extremity within 24 hours after the procedure. No late complications attributable to the ablation were noted, except for a small eschar next to the puncture site.
The results of the present study suggest that percutaneous ablation is preferred to operative excision because it generally requires shorter hospital stay and is not associated with complications. Furthermore, in our experience, pain relief was noted to occur very rapidly in 100% of cases. In agreement with the literature data, our results show that CT-guided percutaneous radio-frequency ablation can actually replace operative excision in the treatment of osteoid osteoma as it achieves the same clinical outcomes with significantly lower costs.
报告我们使用射频消融原位破坏骨样骨瘤的经皮技术的个人经验。
2000年1月至2001年1月，我们对15例患者进行了16次射频消融。所有治疗候选者此前均接受了临床和放射学检查，以确认骨样骨瘤的典型特征。给予脊髓麻醉后，在CT引导下进行操作，使用一根克氏针插入局部病变，并使用一根引导套管。首先用切割器在骨上切一个孔，然后用Jamshidi针获取一些活检标本。最后，我们通过活检通道将一根小的射频电极插入骨内。使用足够的电流将电极尖端加热至85-90摄氏度，从而使组织发生热坏死。持续加热6分钟。
所有患者对经皮操作耐受性良好，只有1例患者进行了第二次成功的射频消融。在所有病例中，均注意到疼痛缓解非常迅速，所有患者在术后24小时内即可在治疗的肢体上完全负重。除穿刺部位旁边有一个小焦痂外，未发现与消融相关的晚期并发症。
本研究结果表明，经皮消融优于手术切除，因为它通常需要较短的住院时间，且不伴有并发症。此外，根据我们的经验，100%的病例均注意到疼痛缓解非常迅速。与文献数据一致，我们的结果表明，CT引导下经皮射频消融在骨样骨瘤的治疗中实际上可以替代手术切除，因为它能达到相同的临床效果，且成本显著降低。
