Tanrıverdi Bülent, Erbahçeci Salık Aysun, Çetingök Halil, Edipoğlu Erdem, Bilgili Mustafa Gökhan, Güven Koray, Saçan Filiz
Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği, 34147 Bakırköy İstanbul, Türkiye.
Jt Dis Relat Surg. 2020;31(2):255-259. doi: 10.5606/ehc.2020.71413. Epub 2020 Jun 18.
This study aims to present the importance of a multidisciplinary approach to radiofrequency ablation (RFA) treatment in osteoid osteoma (OO) patients by a team of experts in their field in preventing recurrence and complications.
For this retrospective study, a team of two orthopedists, two interventional radiologists, and one anesthesiologist was established in January 2013 to manage the diagnosis, follow-up, and treatment process of patients with OO at Bakırköy Dr. Sadi Konuk Training and Research Hospital. A total of 27 patients (15 males, 12 females; mean age 22.9 years; range, 9 to 54 years) were treated by this team between February 2013 and September 2016. The anatomic localization included iliac crest in four patients, the femur in 12 patients, fibula in two patients, humerus in three patients, radius in one patient, tibia in three patients, talus in one patient, and metacarpal in one patient. The procedures were carried out by the same interventional radiologists, same orthopedic surgeons, and same anesthesiologist in the computed tomography (CT) unit under aseptic conditions. After appropriate anesthesia for the localization of OO, the patient was positioned on the CT bed and the localization of the lesion was confirmed with a CT scan mapping. Then, a bone penetration cannula was advanced and bone cortex was penetrated with a charged motor and Kirschner (K)-wire. When the cannula reached the nidus, it was replaced with RFA probe. Ablation of the nidus was performed for five minutes at 90°C.
The mean follow-up period was 46 months (range, 25 to 66 months). Patients were evaluated with visual analog scale (VAS) scores preoperatively and at postoperative 15th day, sixth month, and first year. In the last evaluation of the study data, the patients were called by telephone and questioned whether there were any changes in their final status. The mean preoperative VAS score was 7.2. The mean postoperative VAS scores of the 15th day, sixth month, and first year were 1.3, 0.6, and 0, respectively. In the last follow-up, the OO-related pain completely disappeared and none of the patients had any recurrence. There was a significant difference between preoperative and postoperative 15th day and sixth month VAS score measurements.
Radiofrequency ablation treatment of OOs is a minimally invasive, safe, low-cost, and efficient method. We believe that with experienced teams and appropriate planning, RFA will take part in practice as the standard treatment of OO.
本研究旨在阐述由该领域专家组成的团队采用多学科方法对骨样骨瘤（OO）患者进行射频消融（RFA）治疗在预防复发和并发症方面的重要性。
在这项回顾性研究中，2013年1月组建了一个由两名骨科医生、两名介入放射科医生和一名麻醉医生组成的团队，负责在巴基尔柯伊萨迪·科努克培训与研究医院对OO患者进行诊断、随访和治疗。2013年2月至2016年9月期间，该团队共治疗了27例患者（15例男性，12例女性；平均年龄22.9岁；范围为9至54岁）。解剖定位包括4例患者的髂嵴、12例患者的股骨、2例患者的腓骨、3例患者的肱骨、1例患者的桡骨、3例患者的胫骨、1例患者的距骨和1例患者的掌骨。手术由同一名介入放射科医生、同一名骨科医生和同一名麻醉医生在计算机断层扫描（CT）室无菌条件下进行。在对OO进行适当麻醉定位后，将患者置于CT床上，通过CT扫描定位确认病变位置。然后，推进骨穿刺套管，使用电动和克氏（K）针穿透骨皮质。当套管到达病灶时，将其换成RFA探头。在90°C下对病灶进行5分钟的消融。
平均随访期为46个月（范围为25至66个月）。在术前、术后第15天、第六个月和第一年，使用视觉模拟量表（VAS）评分对患者进行评估。在对研究数据的最后评估中，通过电话联系患者，询问其最终状况是否有任何变化。术前VAS平均评分为7.2。术后第15天、第六个月和第一年的VAS平均评分分别为1.3、0.6和0。在最后一次随访中，与OO相关的疼痛完全消失，且无一例患者复发。术前与术后第15天和第六个月的VAS评分测量存在显著差异。
射频消融治疗OO是一种微创且安全、低成本且高效的方法。我们认为，有了经验丰富的团队和适当的规划，RFA将作为OO的标准治疗方法应用于临床实践。
