Peyser Amos, Applbaum Yaakov, Simanovsky Naum, Safran Ori, Lamdan Ron
Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Ann Surg Oncol. 2009 Oct;16(10):2856-61. doi: 10.1245/s10434-009-0604-4. Epub 2009 Jul 21.
Radiofrequency ablation (RFA) has a success rate of 70% to 90% in the treatment of osteoid osteoma (OO). Failures are due to malpositioning of probes or incomplete ablation, possibly related to conventional probes' small heating diameter (range, .5-.8 cm). Cooled-tip probes have a larger heating distance, ablating up to 3 cm, affecting a larger volume, and improving success rate in adults. Concerns regarding damage to surrounding structures and unknown effects on bony growth potential have delayed the widespread use of cooled tips in children. Our goal was to examine whether this technique, when added to conventional RFA, improves the clinical results and whether it carries any additional risks to children.
A total of 22 patients with OO, 15 boys and 7 girls aged 3.5 to 18 years, were treated with the Cool-tip Tyco probe (Valleylab, Boulder, CO). Fifteen lesions were located in the femur, two in the tibia, and the remainder in the humerus, talus, calcaneus, second metatarsus, and sacrum. The OO was intra-articular in five patients: three in the femur, and one each in the calcaneus and talus. Average postoperative follow-up was 38.5 (range, 16-66) months.
The symptoms of all but one patient resolved immediately after a single RFA treatment. One patient experienced partial relief and underwent a second successful ablation. One patient experienced recurrence of disease after 18 months, and one superficial infection occurred. No fractures, neurovascular complications, or growth disturbances were found.
The cooled-tip probe is highly effective and safe for the treatment of pediatric osteoid osteoma, with no adverse events in this age group.
射频消融（RFA）治疗骨样骨瘤（OO）的成功率为70%至90%。治疗失败是由于探头定位不当或消融不完全，这可能与传统探头较小的加热直径（范围为0.5 - 0.8厘米）有关。冷端探头具有更大的加热距离，可消融达3厘米，影响更大的体积，并提高成人的成功率。对周围结构损伤的担忧以及对骨骼生长潜力未知影响的顾虑，延迟了冷端探头在儿童中的广泛应用。我们的目标是研究该技术在常规RFA基础上是否能改善临床结果，以及对儿童是否存在任何额外风险。
总共22例骨样骨瘤患者，年龄3.5至18岁，其中15例为男孩，7例为女孩，接受了冷端泰科探头（Valleylab，博尔德，科罗拉多州）治疗。15个病灶位于股骨，2个位于胫骨，其余位于肱骨、距骨、跟骨、第二跖骨和骶骨。5例患者的骨样骨瘤位于关节内：3例在股骨，跟骨和距骨各1例。术后平均随访时间为38.5（范围16 - 66）个月。
除1例患者外，所有患者在单次RFA治疗后症状立即缓解。1例患者症状部分缓解，接受了第二次成功消融。1例患者在18个月后疾病复发，发生1例浅表感染。未发现骨折、神经血管并发症或生长障碍。
冷端探头治疗儿童骨样骨瘤高效且安全，该年龄组未出现不良事件。
