Dodré Emilie, Lefebvre Guillaume, Cockenpot Eric, Chastanet Patrick, Cotten Anne
Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Lille, France.
Br J Radiol. 2016;89(1057):20150408. doi: 10.1259/bjr.20150408. Epub 2015 Sep 23.
Percutaneous musculoskeletal procedures are widely accepted as low invasive, highly effective, efficient and safe methods in a vast amount of hip pathologies either in diagnostic or in therapeutic management. Hip intra-articular injections are used for the symptomatic treatment of osteoarthritis. Peritendinous or intrabursal corticosteroid injections can be used for the symptomatic treatment of greater trochanteric pain syndrome and anterior iliopsoas impingement. In past decades, the role of interventional radiology has rapidly increased in metastatic disease, thanks to the development of many ablative techniques. Image-guided percutaneous ablation of skeletal metastases provides a minimally invasive treatment option that appears to be a safe and effective palliative treatment for localized painful lytic lesion. Methods of tumour destruction based on temperature, such as radiofrequency ablation (RFA) and cryotherapy, are performed for the management of musculoskeletal metastases. MR-guided focused ultrasound surgery provides a non-invasive alternative to these ablative methods. Cementoplasty is now widely used for pain management and consolidation of acetabular metastases and can be combined with RFA. RFA is also used to treat benign tumours, namely osteoid osteomas. New interventional procedures such as percutaneous screw fixation are also proposed to treat non-displaced or minimally displaced acetabular roof fractures.
经皮肌肉骨骼手术在大量髋关节疾病的诊断或治疗管理中被广泛认为是低侵入性、高效、有效且安全的方法。髋关节腔内注射用于骨关节炎的对症治疗。肌腱周围或滑囊内皮质类固醇注射可用于大转子疼痛综合征和髂腰肌前撞击症的对症治疗。在过去几十年中,由于许多消融技术的发展,介入放射学在转移性疾病中的作用迅速增加。影像引导下经皮消融骨骼转移瘤提供了一种微创治疗选择,似乎是一种安全有效的局部疼痛性溶骨性病变的姑息治疗方法。基于温度的肿瘤破坏方法,如射频消融(RFA)和冷冻疗法,用于肌肉骨骼转移瘤的管理。磁共振引导聚焦超声手术为这些消融方法提供了一种非侵入性替代方案。骨水泥成形术目前广泛用于髋臼转移瘤的疼痛管理和巩固,并且可以与RFA联合使用。RFA还用于治疗良性肿瘤,即骨样骨瘤。还提出了诸如经皮螺钉固定等新的介入手术来治疗无移位或轻度移位的髋臼顶骨折。