Zhang Fa,Li Weiqiang,Wang Shangchong,et al.Comparative study of orthopedic robot-assisted percutaneous resection versus radiofrequency ablation for osteoid osteoma in children guided by 3D-CT[J].Journal of Clinical Pediatric Surgery,2026,(01):15-19.[doi:10.3760/cma.j.cn101785-20251106-00049]
骨科机器人联合三维CT引导下旋切术与射频消融术治疗儿童骨样骨瘤的对比研究
- Title:
- Comparative study of orthopedic robot-assisted percutaneous resection versus radiofrequency ablation for osteoid osteoma in children guided by 3D-CT
- Keywords:
- Robotic Surgical Procedures; Osteoid Osteoma; Radiofrequency Therapy; Surgical Procedures; Operative; Child
- 摘要:
- 目的 比较骨科机器人联合三维CT引导下旋切术与射频消融术治疗儿童骨样骨瘤的疗效。方法 回顾性分析2017年1月至2024年12月佛山市中医院收治的29例骨样骨瘤患儿资料,按照手术方式的不同分为旋切组(n=15)和射频组(n=14)。两组均在骨科机器人辅助下定位,旋切组配合三维CT扫描对骨样骨瘤进行旋切治疗,射频组采用三维CT扫描配合射频消融治疗。对比分析接受两种手术方式患儿术前及术后1周、4周的疼痛视觉模拟评分(visual analog scale,VAS)、手术总时间、瘤巢切除时间、术中出血量、病检成功率、术后并发症。结果 旋切组与射频组患儿手术总时间[101.0(90.0,115.0) min比85.5(78.8,92.5) min]、瘤巢切除时间[(71.9±15.0) min比(52.6±8.7) min]、病检成功率(14/15比9/14)比较,差异均有统计学意义(P<0.05);但两组术中出血量差异无统计学意义(P>0.05)。两组患儿术后1周[(1.3±0.9)分比(1.3±1.1)分]、4周[(0.0±0.0)分比(0.0±0.0)分]VAS评分均较前一阶段改善,差异具有统计学意义(P<0.05)。两组术中均无一例行植骨和内固定,后期均无一例发生病理性骨折。术后随访6~24个月。旋切组中有2例术后发生局部血肿,经加强外敷药物治疗后,均于3周内痊愈;射频组中2例术后出现浅表皮肤灼伤,另有2例射频组患儿在术后随访期间被发现存在遗留疼痛,上述疼痛患儿经功能锻炼联合药膏贴敷治疗后,疼痛症状均完全消失。两组均无一例复发。结论 与射频消融术相比,环钻切除术虽手术时间及瘤巢切除时间延长,但具有病检成功率高的明确优势。
- Abstract:
- Objective To compare the efficacies,advantages and disadvantages of orthopedic robot assisted,three-dimensional computed tomography (CT) guided positioning rotary cutting and radiofrequency ablation for pediatric osteoid osteoma (OO). Methods A retrospective analysis was conducted for the relevant clinical data of 29 OO children admitted to Foshan Hospital of Traditional Chinese Medicine from January 2017 to December 2024.Based upon different surgical approaches,they were assigned into two groups of rotary resection (n=15) and radiofrequency (n=14).Both groups were positioned with an assistance of orthopedic robots.Rotary cutting group underwent three-dimensional CT scanning for OO while radiofrequency group three-dimensional CT scanning plus radiofrequency ablation.After treatment,a comparative analysis was conducted for pain visual analog scale (VAS),total operative duration,tumor nest clearance time,intraoperative blood loss,success rate of pathological examination and postoperative complications at pre-operation and Week 1/4 post-operation. Results Total operative duration[101.0(90.0,115.0) vs. 85.5(78.8,92.5) min],tumor nest resection time[71.9±15.0) vs. (52.6±8.7) min]and success rate of pathological examination (14/15 vs. 9/14) differed significantly between rotary resection and radiofrequency groups (P<0.05); However,no statistically significant inter-group difference existed in intraoperative volume of hemorrhage (P>0.05).At Week 1/4 post-operation,VAS scores in both groups showed significant improvements compared to their preoperative baselines[(1.3±0.9) vs. (1.3±1.1); (0.0±0.0) vs. (0.0±0.0),respectively](P<0.05).Neither groups underwent bone grafting or internal fixation during surgery and no pathological fractures occurred in the later stages.The follow-up period was (6-24) month.Two children in rotary resection group developed local hematomas post-operation and both recovered within 3 weeks after enhanced external medication treatment; Two children in radiofrequency group experienced superficial skin burns post-operation and another two had residual pain during postoperative follow-ups.After functional exercise plus ointment application,pain symptoms completely disappeared.There was no recurrence in either group. Conclusions As compared with radiofrequency group,rotary resection group offered a definite advantage of higher success rate in pathological examination.However,operative duration and tumor nest resection time become prolonged.
参考文献/References:
[1] Wang TL,Luo YP,Zhou ZF,et al.O-arm-navigated,robot-assisted versus conventional CT guided radiofrequency ablation in treatment of osteoid osteoma:a retrospective cohort study[J].Front Surg,2022,9:881852.DOI:10.3389/fsurg.2022.881852.
[2] Ciftdemir M,Tuncel SA,Usta U.Atypical osteoid osteomas[J].Eur J Orthop Surg Traumatol,2015,25(1):17-27.DOI:10.1007/s00590-013-1291-1.
[3] Tepelenis K,Skandalakis GP,Papathanakos G,et al.Osteoid osteoma:an updated review of epidemiology,pathogenesis,clinical presentation,radiological features,and treatment option[J].In Vivo,2021,35(4):1929-1938.DOI:10.21873/invivo.12459.
[4] Parmeggiani A,Martella C,Ceccarelli L,et al.Osteoid osteoma:which is the best mininvasive treatment option?[J].Eur J Orthop Surg Traumatol,2021,31(8):1611-1624.DOI:10.1007/s00590-021-02946-w.
[5] Bramhe S,Pathak SS.Robotic surgery:a narrative review[J].Cureus,2022,14(9):e29179.DOI:10.7759/cureus.29179.
[6] Carneiro BC,Da Cruz IAN,Ormond Filho AG,et al.Osteoid osteoma:the great mimicker[J].Insights Imaging,2021,12(1):32.DOI:10.1186/s13244-021-00978-8.
[7] Zhang YX,Rosenberg AE.Bone-forming tumors[J].Surg Pathol Clin,2017,10(3):513-535.DOI:10.1016/j.path.2017.04.006.
[8] Zeng H,He HB,Tong XP,et al.Osteoid osteoma of the proximal femur:pitfalls in diagnosis and performance of open surgical resection[J].Front Surg,2022,9:922317.DOI:10.3389/fsurg.2022.922317.
[9] De Filippo M,Russo U,Papapietro VR,et al.Radiofrequency ablation of osteoid osteoma[J].Acta Biomed,2018,89(1-S):175-185.DOI:10.23750/abm.v89i1-S.7021.
[10] Mutlu IN,Cingoz M,Guzelbey T,et al.Percutaneous CT-guided microwave ablation for the treatment of osteoid osteomas:a single center experience[J].Acad Radiol,2024,31(9):3725-3731.DOI:10.1016/j.acra.2024.02.025.
[11] Bhakhar A,Sharma A,Kaganur R,et al.Outcomes of osteoid osteoma treated by percutaneous CT-guided radiofrequency ablation[J].Cureus,2023,15(7):e42675.DOI:10.7759/cureus.42675.
[12] Preston DL,Cullings H,Suyama A,et al.Solid cancer incidence in atomic bomb survivors exposed in utero or as young children[J].J Natl Cancer Inst,2008,100(6):428-436.DOI:10.1093/jnci/djn045.
[13] Redpath JL.Nonlinear response for neoplastic transformation following low doses of low let radiation[J].Nonlinearity Biol Toxicol Med,2005,3(1):113-124.DOI:10.2201/nonlin.003.01.007.
[14] Fujiwara T,Kunisada T,Takeda K,et al.Mini-open excision of osteoid osteoma using intraoperative O-arm/Stealth navigation[J].J Orthop Sci,2019,24(2):337-341.DOI:10.1016/j.jos.2018.09.017.
[15] Kraus M,Fischer E,Gebhard F,et al.Image quality and effective dose of a robotic flat panel 3D C-arm vs computed tomography[J].Int J Med Robot,2016,12(4):743-750.DOI:10.1002/rcs.1718.
[16] Li K,Li JM,Li ZH,et al.Robot-assisted percutaneous radiofrequency ablation for the treatment of osteoid osteomas[J].Orthop Surg,2024,16(5):1246-1251.DOI:10.1111/os.14043.
相似文献/References:
[1]张书豪,高志刚,钭金法,等.机器人手术在小儿外科领域的应用现状[J].临床小儿外科杂志,2021,20(08):701.[doi:10.12260/lcxewkzz.2021.08.001]
Zhang Shuhao,Gao Zhigang,Tou Jinfa,et al.Current applications of robotic procedures in pediatric surgery[J].Journal of Clinical Pediatric Surgery,2021,20(01):701.[doi:10.12260/lcxewkzz.2021.08.001]
[2]谭征,俞建根,梁靓,等.机器人辅助胸腔镜技术治疗小儿先天性肺部疾病的单中心研究[J].临床小儿外科杂志,2021,20(08):708.[doi:10.12260/lcxewkzz.2021.08.002]
Tan Zheng,Yu Jiangeng,Liang Liang,et al.Robot-assisted thoracoscopy in the treatment of congenital pulmonary diseases in children[J].Journal of Clinical Pediatric Surgery,2021,20(01):708.[doi:10.12260/lcxewkzz.2021.08.002]
[3]赵扬,周辉霞,马立飞,等.机器人辅助腹腔镜技术应用于儿童肾上腺肿物切除术的初步经验[J].临床小儿外科杂志,2021,20(08):712.[doi:10.12260/lcxewkzz.2021.08.003]
Zhao Yang,Zhou Huixia,Ma Lifei,et al.Preliminary experience of robot-assisted laparoscopic adrenal mass resection in children[J].Journal of Clinical Pediatric Surgery,2021,20(01):712.[doi:10.12260/lcxewkzz.2021.08.003]
[4]章跃滨,陈青江,蔡多特,等.机器人手术系统辅助儿童脾切除术三例并文献复习[J].临床小儿外科杂志,2021,20(08):718.[doi:10.12260/lcxewkzz.2021.08.004]
Zhang Yuebin,Chen Qingjiang,Cai Duote,et al.Robot-assisted laparoscopic splenectomy in children: a report of 3 cases with review of the literature[J].Journal of Clinical Pediatric Surgery,2021,20(01):718.[doi:10.12260/lcxewkzz.2021.08.004]
[5]马洪,汤显能,郭跃明.机器人手术系统辅助经皮原位固定术治疗儿童股骨头骨骺滑脱的比较研究[J].临床小儿外科杂志,2021,20(08):724.[doi:10.12260/lcxewkzz.2021.08.005]
Ma Hong,Tang Xianneng,Guo Yueming.Comparative study of percutaneous in stu fixation of slipped capital femoral epiphysis assisted by surgical robotic system[J].Journal of Clinical Pediatric Surgery,2021,20(01):724.[doi:10.12260/lcxewkzz.2021.08.005]
[6]陈艳,周立军,汪亚平,等.机器人辅助腹腔镜技术治疗儿童肾上腺嗜铬细胞瘤一例并文献复习[J].临床小儿外科杂志,2021,20(08):731.[doi:10.12260/lcxewkzz.2021.08.006]
Chen Yan,Zhou Lijun,Wang Yaping,et al.Robot-assisted laparoscopic adrenalectomy for children with adrenal pheochromocytoma: one case report with a literature review[J].Journal of Clinical Pediatric Surgery,2021,20(01):731.[doi:10.12260/lcxewkzz.2021.08.006]
[7]胡家祥,聂梅兰,杨嘉飞,等.儿童上尿路结石的外科治疗进展[J].临床小儿外科杂志,2021,20(10):985.[doi:10.12260/lcxewkzz.2021.10.017]
Hu Jiaxiang,Nie Meilan,Yang Jiafei,et al.Recent advances in surgical treatment of upper urinary calculi in children[J].Journal of Clinical Pediatric Surgery,2021,20(01):985.[doi:10.12260/lcxewkzz.2021.10.017]
[8]朱炜玮,周辉霞,李品,等.机器人辅助腹腔镜Lich-Gregoir输尿管再植术与气膀胱Cohen输尿管再植术治疗原发性膀胱输尿管反流的疗效对比[J].临床小儿外科杂志,2022,21(05):437.[doi:10.3760/cma.j.cn101785-202109034-008]
Zhu Weiwei,Zhou huixia,Li Pin,et al.Comparison of clinical efficacy of robot-assisted laparoscopic Lich-Gregoir procedure and gas-bladder laparoscopic Cohen ureteral reimplantation for primary vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2022,21(01):437.[doi:10.3760/cma.j.cn101785-202109034-008]
[9]杨平,李康明,邹兵,等.机器人辅助腹腔镜与传统腹腔镜肾盂成形术治疗小儿肾盂输尿管连接处梗阻的Meta分析[J].临床小儿外科杂志,2022,21(05):482.[doi:10.3760/cma.j.cn101785-202011015-015]
Yang Ping,Li Kangming,Zou Bing,et al.Robotic-assisted laparoscopic pyeloplasty versus laparoscopic pyeloplasty for children with ureteropelvic junction obstruction:Meta-analysis of comparative studies[J].Journal of Clinical Pediatric Surgery,2022,21(01):482.[doi:10.3760/cma.j.cn101785-202011015-015]
[10]董岿然.国内小儿微创外科的热点与趋势[J].临床小儿外科杂志,2022,21(07):601.[doi:10.3760/cma.j.cn101785-202204095-001]
Dong Kuiran.Hotspots and trends of domestic pediatric mini-invasive surgery[J].Journal of Clinical Pediatric Surgery,2022,21(01):601.[doi:10.3760/cma.j.cn101785-202204095-001]
备注/Memo
收稿日期:2025-11-6。
基金项目:佛山市自筹经费类科技创新项目(2420001004268)
通讯作者:王志远,Email:milo8008@126.com