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[肿瘤学中的图像引导骨巩固:骨水泥成形术和经皮螺钉固定]

[Image-guided bone consolidation in oncology: Cementoplasty and percutaneous screw fixation].

作者信息

Buy Xavier, Cazzato Roberto Luigi, Catena Vittorio, Roubaud Guilhem, Kind Michele, Palussiere Jean

机构信息

Institut Bergonié, département de radiologie, 229, cours de l'Argonne, 33000 Bordeaux, France.

Institut Bergonié, département de radiologie, 229, cours de l'Argonne, 33000 Bordeaux, France.

出版信息

Bull Cancer. 2017 May;104(5):423-432. doi: 10.1016/j.bulcan.2016.12.009. Epub 2017 Mar 18.

Abstract

Bone metastases are a common finding in oncology. They often induce pain but also fractures which impair quality of life, especially when involving weight-bearing bones. Percutaneous image-guided consolidation techniques play a major role for the management of bone metastases. Cementoplasty aims to stabilize bone and control pain by injecting acrylic cement into a weakened bone. This minimally invasive technique has proven its efficacy for bones submitted to compression forces: vertebra, acetabular roof, and condyles. However, long bone diaphysis should be treated with caution due to lower resistance of the cement subject to torsional forces. The recent improvements of navigation systems allow percutaneous image-guided screw fixation without requiring open surgery. This fast-track procedure avoids postponing introduction of systemic therapies. If needed, cementoplasty can be combined with screw insertion to ensure better anchoring in major osteolysis. Interventional radiology bone consolidation techniques increase the therapeutic field in oncology. A multidisciplinary approach remains mandatory to select the best indications.

摘要

骨转移是肿瘤学中的常见现象。它们常常引发疼痛,还会导致骨折,进而损害生活质量,尤其是当累及负重骨时。经皮影像引导下的骨巩固技术在骨转移的治疗中发挥着重要作用。骨水泥成形术旨在通过向弱化的骨内注入丙烯酸骨水泥来稳定骨骼并控制疼痛。这种微创技术已在承受压缩力的骨骼(如椎体、髋臼顶和髁)上证明了其有效性。然而,由于骨水泥在承受扭力时的抵抗力较低,长骨干骺端的治疗应谨慎进行。导航系统的最新改进使得经皮影像引导下的螺钉固定无需进行开放手术。这种快速通道手术避免了推迟全身治疗的引入。如有需要,骨水泥成形术可与螺钉植入相结合,以确保在严重骨质溶解中更好地锚定。介入放射学骨巩固技术扩大了肿瘤学的治疗领域。多学科方法对于选择最佳适应症仍然必不可少。

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