Kurup A Nicholas, Morris Jonathan M, Schmit Grant D, Atwell Thomas D, Schmitz John J, Rose Peter S, Callstrom Matthew R
Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905..
Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905.; Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905.
J Vasc Interv Radiol. 2015 Apr;26(4):588-94. doi: 10.1016/j.jvir.2014.11.023.
To describe the feasibility, safety, and effectiveness of a technique using vertebral augmentation balloons to promote delivery of cement into periacetabular tumors after cryoablation for fracture prevention.
A retrospective review was performed of seven consecutive patients (six men and one woman; mean age, 64 y ± 8) with unilateral periacetabular tumors (mean size, 4.2 cm ± 1.4) treated with cryoablation and balloon-assisted osteoplasty for fracture prevention. Cortical defects were seen in six (86%) tumors, and additional pathologic fractures occurred in five (71%) tumors before treatment. The cohort included six (86%) Harrington class I defects and one (14%) class II defect. Procedures were performed with computed tomography fluoroscopic guidance and general anesthesia. Vertebral augmentation balloons (mean, 2; range, 1-4) were inflated within the ablation cavity immediately before or during cement injection.
All procedures were technically successful. Median percentage tumor fill was 63% (range, 17%-96%). Minor cement leakage occurred in two (29%) patients with no symptomatic or intraarticular extravasation. A new nondisplaced fracture occurred in one patient and was conservatively managed. No major complications occurred. Local tumor progression occurred in one (20%) of five patients with imaging follow-up.
Balloon-assisted osteoplasty after cryoablation of periacetabular tumors appears feasible, safe, and effective for fracture prevention. This technique directs cement instillation into ablation defects with a high degree of filling and minimal leakage.
描述一种使用椎体增强球囊促进骨水泥注入髋臼周围肿瘤以预防骨折的技术的可行性、安全性和有效性，该技术在冷冻消融后使用。
对7例连续患者（6例男性和1例女性；平均年龄64岁±8岁）进行回顾性研究，这些患者均患有单侧髋臼周围肿瘤（平均大小4.2 cm±1.4），接受了冷冻消融和球囊辅助骨成形术以预防骨折。6例（86%）肿瘤可见皮质缺损，5例（71%）肿瘤在治疗前发生了额外的病理性骨折。该队列包括6例（86%）哈灵顿I级缺损和1例（14%）II级缺损。手术在计算机断层扫描荧光透视引导和全身麻醉下进行。在注入骨水泥之前或期间，立即在消融腔内充盈椎体增强球囊（平均2个；范围1 - 4个）。
所有手术在技术上均获成功。肿瘤填充的中位数百分比为63%（范围17% - 96%）。2例（29%）患者发生轻微骨水泥渗漏，无症状或关节内渗漏。1例患者发生了新的无移位骨折，采用保守治疗。未发生重大并发症。5例接受影像学随访的患者中有1例（20%）出现局部肿瘤进展。
髋臼周围肿瘤冷冻消融后球囊辅助骨成形术在预防骨折方面似乎可行、安全且有效。该技术将骨水泥注入消融缺损处，填充度高且渗漏极少。
