目的:经皮CT引导射频消融(CT-RFA)是一种广泛接受的骨样骨瘤治疗方法。然而,由于存在一些弊端,CT-RFA的应用受到限制,例如辐射暴露,和全身麻醉的不便。这项研究的主要目的是评估TiRobot辅助的骨样骨瘤术中经皮RFA的安全性和有效性。
方法:我们回顾性回顾了2021年3月至2022年4月在我们机构接受TiRobot系统引导下的骨样骨瘤经皮RFA治疗的21例患者的医疗档案。通过3DC臂在术中获得的三维图像被发送到TiRobot系统。设计了穿刺点和轨迹。然后在TiRobot的辅助下将引导销定位到病变处,并通过引导销将活检鞘插入病变中。对肿瘤进行活检以进行病理检查。然后通过活检鞘将RFA针插入病灶内进行热消融。提取相关并发症的数据,通过视觉模拟评分(VAS)评估术后1个月和1年的疼痛减轻。采用配对t检验比较术前、术后VAS评分。
结果:患者包括17名男性和4名女性,平均年龄为19.5±10.4岁(范围3-45岁)。9例病变位于股骨,在9例胫骨上,在一个案例中,肱骨上,在一个案例中,跟骨上,在一个案例中,髋臼上。TiRobot辅助经皮RFA对所有21例患者均成功进行。未观察到术中或术后并发症。11例骨样骨瘤的病理诊断,但其他10例没有病理诊断。随访时间12~26个月,平均18.8个月。术后VAS评分均显著降低。平均VAS评分从术前的6.5降至术后1个月的0.5,术后1年的0.1。
结论:作为定位和切除病灶的可靠技术,TiRobot辅助经皮RFA是治疗骨样骨瘤的安全有效选择。
OBJECTIVE: Percutaneous CT-guided radiofrequency ablation (CT-RFA) is a widely accepted procedure for treatment of osteoid osteomas. However, the application of CT-RFA was restricted as a result of some drawbacks, such as radiation exposure, and inconvenience in general anesthesia. The primary aim of this study is to evaluate the safety and efficacy of intra-operative TiRobot-assisted percutaneous RFA of osteoid osteomas.
METHODS: We retrospectively reviewed 21 medical files of patients who were treated with percutaneous RFA of osteoid osteomas guided by the TiRobot system in our institution between March 2021 and April 2022. The three-dimensional images obtained by a 3D C-arm intra-operatively were sent to the TiRobot system. The puncture point and trajectory were designed. Then the guide pin was positioned to the lesion with the assistance of TiRobot and the biopsy sheath was inserted into the lesion through the guide pin. The tumor was biopsied for pathological examination. Then the RFA needle was inserted into the nidus through the biopsy sheath for thermal ablation. Data were extracted on the associated complications, the reduction in pain at 1 month and 1 year postoperatively assessed by the visual analogue scale (VAS). A paired t-test was used to compare the pre-operative and post-operative VAS scores.
RESULTS: The patients included 17 males and four females with a mean age of 19.5 ± 10.4 years (range 3-45 years). Lesions were located on the femur in nine cases, on the tibia in nine cases, on the humerus in one case, on the calcaneus in one case, and on the acetabulum in one case. TiRobot-assisted percutaneous RFA was successfully performed on all 21 patients. There was no intra-operative or post-operative complications observed. Pathological diagnosis of osteoid osteoma was obtained in 11 patients, but the other 10 cases were not pathologically diagnosed. The mean follow-up time was 18.8 months (range: 12-26 months).Post-operative VAS scores were reduced significantly in all cases. The mean VAS score decreased from 6.5 pre-operatively to 0.5 at 1 month post-operatively and to 0.1 at 1 year post-operatively.
CONCLUSIONS: As a reliable technique for localizing and resection of nidus, TiRobot-assisted percutaneous RFA is a safe and effective option for the treatment of osteoid osteomas.