The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Orthop Surg. 2021 Feb;13(1):116-125. doi: 10.1111/os.12849. Epub 2020 Dec 10.
To evaluate the feasibility and safety of treating painful osseous metastases using image-guided percutaneous thermal microwave ablation.
This is a retrospective study of patients treated from December 2016 to December 2019 in one institute. A total of 50 patients (35 men, 15 women; mean age 55.24 ± 11.03 years) with 56 osseous metastatic lesions underwent image-guided percutaneous microwave ablation. There were 7 patients with multiple and 43 patients with single metastases. The numbers of patients with primary cancer were as follows: lung, 13; liver, 17; kidney, 10; prostate, 1; breast, 3; osteosarcoma, 1; and thyroid, 5. Seventeen patients had cancer combined with soft tissue masses. The radiological images for the ablative procedures were obtained by CT, fluoroscopy with ultrasound, and fluoroscopy alone in 16, 11, and 23 patients, respectively. Pain severity was estimated using the visual analogue scale before and after treatment (1 week, 1 month, and 3 months after treatment). Radiological evaluations were performed at baseline and 3 months after the procedure.
In all patients, pain reduction occurred from the first day after treatment. Pain did not recur during the 3 months of follow up. The mean total ablation time per microwave electrode was 3.99 ± 2.48 min (range, 1-15 min). The mean power of the microwave electrode was 66.40 ± 12.08 W. The average volume of bone (load-bearing bone, such as vertebra and acetabulum) cement after ablation was 2.82 ± 0.81 mL. There were no significant differences in visual analogue scale pain scores for different imaging techniques or ablation energies. No procedure-related complications occurred.
Image-guided percutaneous thermal microwave ablation of osseous metastases relieves pain and improves mobility. CT remains the first choice for percutaneous ablation. Fluoroscopy combined with ultrasound is effective for cases with soft tissue masses; fluoroscopy is also suitable for combination with vertebroplasty. However, further investigations are required.
评估在影像引导下经皮热微波消融治疗疼痛性骨转移瘤的可行性和安全性。
这是一项回顾性研究，纳入了 2016 年 12 月至 2019 年 12 月在一家机构接受治疗的 50 名患者（35 名男性，15 名女性；平均年龄 55.24±11.03 岁），共 56 个骨转移瘤病灶接受了影像引导下经皮微波消融治疗。其中 7 例为多发病灶，43 例为单发病灶。原发性癌症患者的数量如下：肺癌 13 例，肝癌 17 例，肾癌 10 例，前列腺癌 1 例，乳腺癌 3 例，骨肉瘤 1 例，甲状腺癌 5 例。17 例患者合并软组织肿块。16、11 和 23 例患者分别通过 CT、超声透视和透视获得消融手术的影像学图像。在治疗前后（治疗后 1 周、1 个月和 3 个月）使用视觉模拟评分法评估疼痛严重程度。在基线和治疗后 3 个月进行影像学评估。
所有患者在治疗后第 1 天疼痛减轻，3 个月随访期间未复发。每个微波电极的平均总消融时间为 3.99±2.48 分钟（范围 1-15 分钟）。微波电极的平均功率为 66.40±12.08W。消融后骨（承重骨，如椎体和髋臼）水泥的平均体积为 2.82±0.81mL。不同影像学技术或消融能量的视觉模拟评分疼痛无显著差异。无与治疗相关的并发症发生。
影像引导下经皮热微波消融治疗骨转移瘤可缓解疼痛，提高活动能力。CT 仍然是经皮消融的首选方法。对于合并软组织肿块的病例，透视联合超声是有效的；透视也适用于与椎体成形术相结合。然而，还需要进一步的研究。
