Raux S, Abelin-Genevois K, Canterino I, Chotel F, Kohler R
Service d'orthopédie pédiatrique, hôpital Femme Mère Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France.
Service d'imagerie pédiatrique, hôpital Femme Mère Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France.
Orthop Traumatol Surg Res. 2014 Oct;100(6):641-5. doi: 10.1016/j.otsr.2014.05.017. Epub 2014 Sep 10.
Osteoid osteoma is a benign osteogenic tumor that is mainly located in the lower limbs. According to Campanacci the proximal femur is involved in 25% of cases. We present a series of 44 cases of osteoid osteoma located in the neck of the femur or the lesser trochanter treated by the minimally invasive method, CT-guided percutaneous bone resection and drilling (PBRD).
This series included 44 patients, 20 girls and 24 boys, treated between 1987 and 2012. The average age at surgery was 12.7 years old (range 4-34). The diagnosis was based on the "association" of scintigraphy (hyperfixation) - CT scan (nidus located on the femoral neck or near the lesser trochanter). These patients underwent CT-guided PBRD under general anesthesia. Specific ancillary material was used to reach and remove the nidus and a cylinder of bone was sent to the pathologist for assessment. A lateral or anterior approach was used in all cases except one in which a posterior incision was made. Histological confirmation was obtained in 23 cases (the bone fragment was damaged in 21 cases).
Forty-two patients were reviewed after a minimum follow-up of one year (12-56 months). Two patients were lost to follow-up. Results were evaluated clinically and on CT scan 1 year after surgery: there were 35 cures with complete and permanent pain relief. There were 5 failures and 1 case of recurrence requiring a second CT-guided PBRD procedure as well 2 complications involving femoral fracture (one associated with failure).
The proximal femur is a common location of osteoid osteoma. Treatment requires careful preoperative planning to determine the surgical approach for safe removal. PBRD is a minimally invasive technique, allowing complete resection with suitable ancillary equipment. This method should be compared with thermoablation, which is a similar technique.
CT-guided PBRD is a therapeutic option in case of osteoid osteoma of the proximal femur.
Level IV.
骨样骨瘤是一种主要位于下肢的良性成骨性肿瘤。根据坎帕纳奇的研究，25%的病例累及股骨近端。我们报告了一系列44例位于股骨颈或小转子的骨样骨瘤病例，采用微创方法，即CT引导下经皮骨切除和钻孔术（PBRD）进行治疗。
该系列包括44例患者，其中20例为女孩，24例为男孩，治疗时间为1987年至2012年。手术时的平均年龄为12.7岁（范围4 - 34岁）。诊断基于骨闪烁显像（高摄取）与CT扫描（病灶位于股骨颈或小转子附近）的“联合”表现。这些患者在全身麻醉下接受CT引导下的PBRD。使用特定的辅助材料到达并切除病灶，将一圆柱形骨组织送病理科评估。除1例采用后外侧切口外，所有病例均采用外侧或前侧入路。23例获得组织学证实（21例骨碎片受损）。
42例患者在至少随访1年（12 - 56个月）后接受复查。2例患者失访。术后1年通过临床及CT扫描评估结果：35例治愈，疼痛完全且永久缓解。5例治疗失败，1例复发，需再次行CT引导下PBRD手术，还有2例并发症为股骨骨折（1例与治疗失败相关）。
股骨近端是骨样骨瘤的常见部位。治疗需要仔细的术前规划以确定安全切除的手术入路。PBRD是一种微创技术，使用合适的辅助设备可实现完全切除。该方法应与热消融术这种类似技术进行比较。
CT引导下PBRD是股骨近端骨样骨瘤的一种治疗选择。
四级。
