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目的探讨计算机导航技术辅助经皮射频消融治疗骨样骨瘤手术方法和临床效果。方法回顾性分析2011年6月至2012年11月,我科应用计算机导航辅助经皮射频消融治疗骨样骨瘤13例的临床资料,其中男12例,女1例,平均16.5(8~36)岁。术前均经局部x线、CT、MRI明确诊断。肿瘤位于股骨干4例、股骨粗隆2例、股骨颈2例、股骨髁2例、胫骨干2例、跟骨1例。13例均采用Iso-C3D C型臂术中实时导航,计算机软件均使用Stryker公司的脊柱导航软件。术中导航指引定位,骨活检针(9G)精确到达瘤巢,行穿刺活检,保留套筒,将射频针导入瘤巢,90℃消融6 min。术后进行随访,并采用疼痛视觉类比评分法(VAS)和术后x线、CT判断疗效。结果 13例均获11.2(4~20)个月的随访。全部病例均完成计算机导航辅助下射频消融手术,11例组织病理学确诊为骨样骨瘤,2例组织学无法诊断,病理确诊率85%。术后疼痛即刻缓解,VAS评分显著降低。术前平均4.7,术后3天1_3,术后3个月为0.1,差异有统计学意义(P<0.05)。全部病例随访未见肿瘤复发和疼痛复发。结论经皮射频消融治疗骨样骨瘤是一种简单、安全、有效的治疗方法。计算机导航技术的应用,使术中瘤巢定位更精确,使手术治疗的微创化成为现实。
Objective To investigate the surgical methods and clinical effects of percutaneous radiofrequency ablation (CT) assisted by computer navigation in the treatment of osteoid osteoma. Methods Retrospective analysis from June 2011 to November 2012, our department applied computer-assisted percutaneous radiofrequency ablation of osteoid osteoma in 13 cases of clinical data, including 12 males and 1 females, an average of 16.5 (8 ~ 36 )year old. Preoperative local x-ray, CT, MRI clear diagnosis. The tumors were located in 4 cases of femoral shaft, 2 cases of femur trochanter, 2 cases of femoral neck, femoral condyle in 2 cases, 2 cases of tibia, calcaneus in 1 case. Thirteen patients underwent real-time navigation using Iso-C3D C-arm technique and computer software using Stryker’s spinal navigation software. Intraoperative navigation guide positioning, bone biopsy needle (9G) accurate tumor neoplasm line biopsy, retaining the sleeve, the RF needle into the neoplasm, 90 ℃ ablation 6 min. Postoperative follow-up, and pain visual analogue scale (VAS) and postoperative X-ray, CT to determine the efficacy. Results All the 13 cases were followed up 11.2 (4 ~ 20) months. All cases were completed computer-aided radiofrequency ablation surgery, 11 cases of histopathology diagnosed as osteoid osteoma, 2 cases of histology can not be diagnosed, the pathological diagnosis rate of 85%. Postoperative pain relief immediately, VAS score was significantly lower. The average preoperative 4.7, 3 days after surgery 1_3, 3 months after surgery was 0.1, the difference was statistically significant (P <0.05). All cases were followed up no tumor recurrence and recurrence of pain. Conclusion Percutaneous radiofrequency ablation of osteoid osteoma is a simple, safe and effective treatment. The application of computer navigation technology makes the localization of tumor nests more precise, which makes the minimally invasive surgical treatment a reality.