Rosenthal D I, Hornicek F J, Wolfe M W, Jennings L C, Gebhardt M C, Mankin H J
Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
J Bone Joint Surg Am. 1998 Jun;80(6):815-21. doi: 10.2106/00004623-199806000-00005.
Osteoid osteoma, a benign bone tumor, has traditionally been treated with operative excision. A recently developed method for percutaneous ablation of the tumor has been proposed as an alternative to operative treatment. The relative outcomes of the two approaches to treatment have not previously been compared, to our knowledge. The rates of recurrence and of persistent symptoms were compared in a consecutive series of eighty-seven patients who were managed with operative excision and thirty-eight patients who were managed with percutaneous ablation with radiofrequency. Patients who had a spinal lesion were excluded. The minimum duration of follow-up was two years. There was a recurrence, defined as the need for subsequent intervention, after operative treatment in six (9 per cent) of sixty-eight patients who had been managed for a primary lesion and in two of nineteen who had been managed for a recurrent lesion. The average length of the hospital stay was 4.7 days for the patients who had a primary lesion and 5.1 days for those who had a recurrent lesion. There was a recurrence after percutaneous treatment in four (12 per cent) of thirty-three patients who had been managed for a primary lesion and in none of five who had been managed for a recurrent lesion. The average length of the hospital stay was 0.2 day for these thirty-eight patients. With the numbers available, we could detect no significant difference between the two treatments with regard to the rate of recurrence. The rate of persistent symptoms (that is, symptoms that did not necessitate additional treatment) was greater than the rate of recurrence. According to responses to a questionnaire, eight (30 per cent) of twenty-seven patients had persistent symptoms after operative treatment and six (23 per cent) of twenty-six patients had persistent symptoms after percutaneous treatment with radiofrequency. Two patients had complications after operative excision, necessitating a total of five additional operations. There were no complications associated with the percutaneous method. The results of the present study suggest that percutaneous ablation with radiofrequency is essentially equivalent to operative excision for the treatment of an osteoid osteoma in an extremity. The percutaneous method is preferred for the treatment of extraspinal osteoid osteoma because it generally does not necessitate hospitalization, it has not been associated with complications, and it is associated with a rapid convalescence.
骨样骨瘤是一种良性骨肿瘤，传统上采用手术切除治疗。最近提出了一种经皮消融肿瘤的新方法，作为手术治疗的替代方案。据我们所知，此前尚未比较这两种治疗方法的相对疗效。对连续的87例行手术切除治疗的患者和38例行射频经皮消融治疗的患者的复发率和持续症状发生率进行了比较。排除脊柱病变患者。随访最短时间为两年。在68例接受原发性病变治疗的患者中，有6例（9%）在手术治疗后复发，定义为需要后续干预；在19例接受复发性病变治疗的患者中，有2例复发。原发性病变患者的平均住院时间为4.7天，复发性病变患者为5.1天。在33例接受原发性病变治疗的患者中，有4例（12%）在经皮治疗后复发，在5例接受复发性病变治疗的患者中无复发。这38例患者的平均住院时间为0.2天。就现有数据而言，我们未发现两种治疗方法在复发率方面有显著差异。持续症状（即无需额外治疗的症状）发生率高于复发率。根据问卷调查结果，27例手术治疗患者中有8例（30%）有持续症状，26例射频经皮治疗患者中有6例（23%）有持续症状。2例患者在手术切除后出现并发症，共需要额外进行5次手术。经皮治疗方法未出现并发症。本研究结果表明，射频经皮消融治疗四肢骨样骨瘤在本质上与手术切除等效。经皮治疗方法更适合治疗脊柱外骨样骨瘤，因为它通常无需住院，未出现并发症，且康复迅速。
