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磁共振引导聚焦超声手术治疗非脊柱关节内骨母细胞瘤:单中心回顾性分析的可行性、安全性和结果。

Magnetic resonance-guided focused ultrasound surgery treatment of non-spinal intra-articular osteoblastoma: feasibility, safety, and outcomes in a single-center retrospective analysis.

机构信息

Department of Emergency and Interventional Radiology, San Salvatore Hospital , L'Aquila , Italy.

Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila , L'Aquila , Italy.

出版信息

Int J Hyperthermia. 2019;36(1):768-775. doi: 10.1080/02656736.2019.1639833.

Abstract

Interventional radiology, thanks to its low invasiveness and possibility to reduce the average time for the patients to come back to their normal activity, is becoming more and more promising and diffused in multiple fields. Employed without needles, MRgFUS is probably the less invasive techniques among the ones belonging to the field of interventional radiology. To evaluate safety and effectiveness of MRgFUS in the treatment of a rare and benign, though disabling, bone lesion: intra-articular osteoblastoma. A retrospective study was carried out on 6 patients (mean, 21 years) treated in the last 2 years with MRgFUS for symptomatic, histologically proved intra-articular osteoblastoma. The main inclusion criterion was the presence of a good acoustic window. The procedures consisted in MR-guided ablation, using high intensity ultrasound beams focused on the target lesion. Spinal anesthesia or peripheral nerve block was used. Clinical (based on pain and functional scales) and imaging follow-up studies were performed up to 1 year after treatment. Complications were recorded. Multiple linear regression and analysis of variance were used to assess correlations. All the procedures were technically successful; no complications were observed. Painful symptomatology decreased of 88% at 6 months and 98% at 12 months ( < 0.0001), and was associated to functional improvement ( = 0.002). MRI and CT controls showed disappearance of all signs of disease and bone inflammation with a marked tendency to bone healing. This study shows the safety and effectiveness of MRgFUS in the treatment of intra-articular osteoblastoma with a good acoustic window.

摘要

介入放射学由于其微创性和降低患者恢复正常活动平均时间的可能性,在多个领域变得越来越有前途和普及。MRgFUS 无需使用针头,是介入放射学领域中最微创的技术之一。

评估 MRgFUS 在治疗罕见良性但致残性骨病变(关节内骨母细胞瘤)中的安全性和有效性。

对过去 2 年中接受 MRgFUS 治疗的 6 名(平均年龄 21 岁)有症状、经组织学证实的关节内骨母细胞瘤患者进行了回顾性研究。主要纳入标准是存在良好的声窗。该程序包括使用聚焦于目标病变的高强度超声束进行的 MR 引导消融。使用脊髓麻醉或周围神经阻滞。在治疗后 1 年内进行临床(基于疼痛和功能量表)和影像学随访研究。记录并发症。使用多元线性回归和方差分析评估相关性。

所有手术均技术成功;未观察到并发症。疼痛症状在 6 个月时降低了 88%,在 12 个月时降低了 98%( < 0.0001),并与功能改善相关( = 0.002)。MRI 和 CT 对照显示所有疾病和骨炎症迹象消失,骨愈合有明显趋势。

这项研究表明,对于具有良好声窗的关节内骨母细胞瘤,MRgFUS 治疗是安全有效的。

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