背景:今天,关节镜和射频热消融术治疗关节内和关节近骨样骨瘤。然而,对于肘关节,认为使用微创技术是最佳选择。这项研究旨在分析我们在关节镜下治疗肘部骨样骨瘤的经验,并将其与两种技术的已发表结果进行比较。
方法:回顾性研究分析了2014年1月至2020年3月在一家机构接受肘关节镜下切除肘关节骨样骨瘤的患者。临床和诊断特征,成功率和治疗失败率,将并发症和肿瘤复发率均与13项肘关节内骨样骨瘤关节镜消融研究和15项不同关节内骨样骨瘤射频热消融研究进行比较.
结果:四名男性和两名女性,平均年龄为19.3岁,被包含。所有患者术后疼痛立即缓解,活动范围改善。在中位数为21.7个月期间没有观察到肿瘤复发。文献综述成功率为86.4%,68.2%成功活检,在关节镜下消融术治疗肘关节骨样骨瘤后,有一个较小的并发症,没有复发;而射频热消融术治疗肘关节内骨样骨瘤的成功率为96.3%,33.3%成功活检,无并发症,复发率为3.7%。
结论:我们的结果与已发表的文献一致,证明关节镜消融术是一种有效的方法,治疗失败率低,并且在治疗肘关节内和关节附近骨样骨瘤方面没有复发。关节镜消融术的优势在于能够观察并安全地处理病变和关节反应性变化,从而导致高活检率。无复发,术后肘关节活动度较好。尽管如此,技术选择应该是个性化的考虑到每个机构的医疗专业知识。
BACKGROUND: Today, intra-articular and juxta-articular osteoid osteomas are treated with arthroscopy and radiofrequency thermal ablation. However, for the
case of an elbow joint, arguments are made for the use of a minimally invasive technique to be the optimal choice. This study aims to analyse our experiences of arthroscopically treated elbow osteoid osteomas and to compare it with the published results of both techniques.
METHODS: The retrospective study analyses the patients who underwent elbow arthroscopy ablation of an elbow osteoid osteoma at a single institution from January 2014 until March 2020. Clinical and diagnostic features, success and treatment failure rates, complications and tumour recurrence rates were all compared to 13 studies of intra-articular elbow osteoid osteoma arthroscopic ablation and 15 studies involving radiofrequency thermal ablation of intra-articular osteoid osteoma within different joints.
RESULTS: Four males and two females, with a mean age of 19.3 years, were encompassed. All the patients had immediate postoperative pain relief and improved range of motion. No tumour recurrences were observed during a median of 21.7 months. The literature review yielded 86.4% success rate, 68.2% successful biopsies, one minor complication and no recurrences following the arthroscopic ablation of an elbow osteoid osteoma; while radiofrequency thermal ablation of an intra-articular elbow osteoid osteoma yielded 96.3% success rate, 33.3% successful biopsies, no complications and 3.7% recurrence rate.
CONCLUSIONS: Our results are consistent with the published literature proving that arthroscopic ablation is an efficient method with low treatment failure rates and no recurrences in treating intra- and juxta-articular elbow osteoid osteomas. Advantages of arthroscopic ablation stem from the ability to visualise and safely deal with the lesion and the joint\'s reactive changes resulting in high biopsy rates, no recurrences and better postoperative elbow\'s range of motion. Still, the technique selection should be personalised considering the medical expertise of every institution.