Percutaneous Osteoplasty for the Management of a Femoral Head Metastasis: a Case Report

Percutaneous osteoplasty (POP) as a technical extension of percutaneous vertebroplasty (PVP) has been used to treat malignant disease that affects the skeletal system. POP has demonstrated good outcome for pain relief and functional improvement. Few studies have reported on the efficiency of POP to treat malignancies located in the femoral head. We designed a pilot study with the use of POP to treat intractable pain caused by a femoral head metastatic tumor in a 43-year-old man. During the follow-up period, the patient experienced sustained pain relief and improvement of quality of life that persisted for more than three months.     

Combination of Microwave Ablation and Percutaneous Osteoplasty for Treatment of Painful Extraspinal Bone Metastasis

PurposeTo evaluate the efficacy and safety of microwave (MW) ablation combined with percutaneous osteoplasty (POP) on painful extraspinal bone metastases.Materials and MethodsIn this retrospective study, 50 adult patients with 56 extraspinal bone metastasis lesions, who suffered from refractory moderate to severe pain, were treated with MW ablation and POP. Changes in quality of life were evaluated based on the Visual Analog Scale (VAS), daily morphine consumption, and the Oswestry Disability Index (ODI) before and immediately after the procedure and during follow-up times.ResultsTechnical success was achieved in all patients. Mean preoperative VAS score and morphine dose were 7.0 ± 2.6 (range, 3–10) and 66.7 ± 33.2 mg (range, 10–120 mg), respectively. Mean postoperative VAS scores and daily morphine doses were as follows: 1 day, 3.5 ± 2.1 and 36.1 ± 25.8 mg (P < .05); 1 week, 1.5 ± 1.7 and 12.2 ± 14.8 mg (P < .001); 1 month, 0.9 ± 1.4 and 5.7 ± 10.0 mg (P < .001); and 3 months, 0.6 ± 1.2 and 4.7 ± 8.4 mg (P < .001). A significant decrease in the ODI score was also observed (P < .05). Periprocedural death was not observed. A pathologic fracture occurred in 1 (2%) patient with femoral metastasis, and local infection was observed in 2 (4%) patients. Minor cement leakage occurred in 4 (8%) patients with no symptomatic or intra-articular extravasation. No local tumor progression occurred in patients with imaging follow-up.ConclusionsMW ablation combined with POP is an effective and safe treatment for painful extraspinal bone metastases, which can significantly relieve pain and improve quality of life.     

Combination Radiofrequency Ablation and Percutaneous Osteoplasty for Palliative Treatment of Painful Extraspinal Bone Metastasis: A Single-Center Experience

PurposeTo evaluate combined radiofrequency (RF) ablation and percutaneous osteoplasty (POP) in patients with painful extraspinal bone metastases.Materials and MethodsIn a retrospective study, 38 patients with 54 extraspinal bone metastases (ilium, n = 24; acetabulum, n = 21; femur, n = 7; ischium, n = 1; tibia, n = 1) were treated with RF ablation and POP. All patients had pain refractory to analgesic medication with intensity > 3 on a visual analog scale (VAS). Changes in quality of life were evaluated based on pain relief (VAS score), function on a Karnofsky performance scale, and analgesic dose before and immediately after the procedure and during follow-up. VAS score was the primary outcome, and the others were secondary outcomes.ResultsTechnical success was achieved in 37 patients (97.4%). Mean VAS score declined significantly from 7.1 ± 1.5 before treatment to 2.2 ± 2.0 at 24 hours after treatment (P < .05), 1.6 ± 1.8 at 3 months after treatment (P < .05), and 1.3 ± 1.8 at 6 months after treatment (P < .05). Pain relief immediately after the procedure was reported by 35 patients (92.1%); pain regressed completely in 7 (18.4%) patients. After 6 months, narcotic analgesia had been suspended in 32 of 33 patients (97.0%). Pain was controlled by nonsteroidal antiinflammatory drugs in 8 patients (24.2%), and no analgesia was necessary in 24 patients (72.7%). Mean Karnofsky performance scale score after treatment was higher than before treatment (P < .05). The major complication rate was 2.6% (1 of 38 patients), with one case of vasovagal shock. The minor complication rate was 23.7% (9 of 38 patients).ConclusionsRF ablation with POP is effective for pain relief and functional recovery in patients with painful extraspinal bone metastases and can significantly improve quality of life.     

Development of a Searchable Database of Cryoablation Simulations for Use in Treatment Planning

CardioVascular and Interventional Radiology - To create and validate a planning tool for multiple-probe cryoablation, using simulations of ice ball size and shape for various ablation probe...     

Hip Chondrolysis and Femoral Head Osteonecrosis: A Complication of Periacetabular Cryoablation

PurposeTo describe a new complication and retrospectively identify the incidence and risk factors for hip chondrolysis and femoral head osteonecrosis associated with percutaneous cryoablation of periacetabular malignancies.Materials and MethodsIn this retrospective study, 45 patients with a total of 113 musculoskeletal lesions were treated by percutaneous image-guided cryoablation between May 2008 and June 2013. Included in the treated population were 10 patients with a total of 12 periacetabular lesions. Clinical and imaging follow-up of at least 2 months was reviewed for evidence of femoral head osteonecrosis or hip chondrolysis. Parametric and nonparametric statistical methods were used to assess patient demographics and treatment technique and parameters on the development of hip chondrolysis/femoral head osteonecrosis.ResultsHip chondrolysis/femoral head osteonecrosis developed in 40% of patients (four of 10) and in 33% of treated periacetabular lesions (four of 12). All patients in whom chondrolysis/osteonecrosis developed were women. Needle proximity to the acetabulum (< 5 mm) was a significant predictor of chondrolysis/osteonecrosis development (P = .01). Three of the four patients in whom chondrolysis/osteonecrosis developed have undergone total joint replacement.ConclusionsPeriacetabular cryoablation can result in transarticular extension of the ablation zone, which may result in the development of hip chondrolysis and femoral head osteonecrosis. The proximity of the cryoablation probe to the acetabulum is a significant risk factor in the development of this complication.     

改良克氏针加PDS缝线治疗锁骨骨折

采用克氏针内固定加PDS缝线治疗锁骨骨折62例,本文探讨内固定治疗锁骨骨折的方法。     

Clinical Outcomes after Pulmonary Cryoablation with the Use of a Triple Freeze Protocol

Purpose

To elucidate clinical variables associated with safety and efficacy in patients after cryoablation of pulmonary tumors with the use of a triple freeze protocol.

经皮克氏针抓髌器固定治疗髌骨骨折

应用克氏针和抓髌器联合固定治疗29例髌骨骨折，26例随访1年，膝关节屈伸功能正常，步态正常，无骨折不愈合、感染、骨折再移位发生。     

背伸阻挡加压克氏针治疗骨性锤状指

目的探讨背伸阻挡加压克氏针治疗mallet骨折的疗效。方法 2004年5月~2009年6月,应用背伸阻挡加压克氏针治疗23例骨性锤状指,其中Ⅰa型2例,Ⅰb型8例,Ⅱa型7例,Ⅱb型4例,Ⅲb型2例。结果所有患者术后获5~31个月（平均15个月）随访,23例平均愈合时间为6 w。术后疗效评定：优14例,良7例,可2例,优良率为91.3%。术后未发生针道感染、克氏针松动、皮缘及甲床压迫坏死及甲板畸形。结论背伸阻挡加压克氏针技术是一种简单有效的治疗骨性锤状指手术方法。     

Treatment of Bone Metastasis with Bone-Targeting Radiopharmaceuticals

Bone is a common metastatic site of cancer. Bone metastasis reduces life expectancy and results in serious symptoms and complications such as bone pain, pathological fractures, and spinal cord compression, decreasing quality of life by restricting sleep and mobility. Treatment for bone metastasis includes drugs (pure analgesics, hormones, cytotoxic chemotherapy, and bisphosphonates, among others), external radiation therapy, surgery, and radionuclide therapy using bone-targeting radiopharmaceuticals. Particulate radiation with α- or β-rays is used as a bone-targeting radiopharmaceutical in radionuclide therapy. β-Emitters have lower energy and a longer range than α-emitters and have less tumoricidal activity and deliver more radiation to adjacent normal tissue. Therefore, the main therapeutic effect of bone-targeting β-emitters such as ⁸⁹Sr-dichloride is bone pain palliation rather than enhanced survival. In contrast, α-emitters such as ²²³Ra-dichloride have high energy and a short range, resulting in greater tumoricidal activity and less radiation damage to adjacent normal tissue. Treatment with bone-targeting α-emitters can improve survival and decrease bone pain. This review focuses on the principles and clinical utility of several clinically available bone-targeting radiopharmaceuticals in metastatic bone disease.     

Interventional Radiology Management of a Ruptured Lumbar Artery Pseudoaneurysm after Cryoablation and Vertebroplasty of a Lumbar Metastasis

CardioVascular and Interventional Radiology - We describe the management of a complication (a lumbar artery pseudoaneurysm and its rupture) after combined procedure (cryoablation and...     

射频消融术联合经皮骨成形术治疗椎外转移性骨肿瘤的临床应用

目的 探讨DSA引导下射频消融术(radiofrequency ablation,RFA)联合经皮骨成形术(pecutaneous osteoplasty,POP)治疗椎体外转移性骨肿瘤的手术方法及临床疗效.方法 回顾性分析38例(54个病灶)行RFA联合POP治疗的椎外骨转移性肿瘤患者资料,年龄23 ～75岁,平均(52.6±12.2)岁.共54个转移灶得到治疗,其中髂骨24处、髋臼21处、股骨7处、坐骨1处、胫骨1处.所有患者至少随访3个月,通过术前、术后视觉模拟评分(visual analog scale,VAS)、止痛药服用剂量的变化以及运动功能的改善情况评价临床效果.结果 38例手术均获得成功.术后24 h VAS评分由术前平均(7.1±1.5)分降至术后(2.2±2.0)分,术后3个月降至(1.6±1.8)分,术后6个月降至(1.3±1.8)分.术后7例(18.4％)疼痛完全缓解,25例(65.8％)完全无需止痛药,10例(26.3％)止痛药用量减少或止痛药级别降级,2例(5.3％)维持原剂量,1例(2.6％)使用止痛药级别升级.33例行走困难者中20例(60.6％)术后行动功能改善,其中4例可正常行走;12例(36.4％)仍然行走困难;1例(3％)行动不便加重,稍微活动即疼痛难忍.术后患者中位生存时间为15个月,1年生存率为68.9％,2年生存率为27.3％.8例(21.1％)发生肿瘤周围软组织骨水泥渗漏,但无明显临床症状,1例(2.6％)发生皮肤灼伤.结论 DSA引导下行RFA联合POP治疗椎外转移性骨肿瘤临床效果良好、创伤小、并发症少,可以明显提高患者生存质量.     

Computed Tomography‒Guided Microwave Ablation Combined with Osteoplasty for the Treatment of Bone Metastases: A Multicenter Clinical Study

PurposeTo evaluate the efficacy and safety of combined microwave ablation (MWA) and osteoplasty as a palliative therapy for painful bone metastases.Materials and MethodsAs an extension of a previous limited single-center study, a retrospective review was conducted for 147 patients (77 male, 70 female) with painful bone metastases who underwent MWA combined with osteoplasty. In total, 102 (69.4%), 41 (27.9%), and 4 (2.7%) patients had spinal metastases, extraspinal metastases, and both, respectively. Treatment efficacy was determined by comparing visual analog scale (VAS) scores, daily morphine equivalent opioid consumption, and Oswestry disability index (ODI) scores before treatment and during the follow-up period (mean follow-up, 9.8 months; range 3–16).ResultsThe mean VAS score significantly declined from 6.4 ± 2.3 before treatment to 3.2 ± 2.1, 1.9 ± 1.6, 1.8 ± 1.6, 1.8 ± 1.6, and 1.9 ± 1.6 at 24 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks after treatment, respectively (P < .01). Furthermore, the mean daily morphine equivalent opioid consumption was significantly reduced from 81.5 ± 32.8 mg before treatment to 40.0 ± 20.6, 32.4 ± 10.2, 26.4 ± 10.0, 21.5 ± 8.3, and 19.3 ± 7.4 mg. The mean ODI score also declined after treatment (P < .0001). Major complications occurred in 4 of 147 patients, with 1 pathologic fracture, 1 nerve injury, and 2 mild skin infections. Minor cement leakages were observed at 69 sites (32.8%).ConclusionsMWA combined with osteoplasty is an effective and safe treatment for painful bone metastases.     

Percutaneous CT-guided Cryoablation of the Dorsal Penile Nerve for Treatment of Symptomatic Premature Ejaculation

PurposeTo evaluate expansion of image-guided interventional cryoablation techniques usually employed for pain management to address the feasibility, safety, and efficacy of treatment for a urologic condition with otherwise limited treatment options, premature ejaculation (PE).Materials and MethodsProspective institutional review board approval was obtained, and 24 subjects with PE were enrolled. All patients underwent unilateral percutaneous computed tomography–guided cryoablation of the dorsal penile nerve (DPN). Postprocedural intravaginal ejaculatory latency times (IELTs) and PE Profile (PEP) results served as outcome variables. In addition, subjects were asked whether they would have the procedure done again based on their experience at the 180- and 360-day marks.ResultsThe technical success rate was 100%. Baseline average IELT was 54.7 seconds±7.8 (n = 24), which increased to a maximum of 256 seconds±104 (n = 11; P = .241) by day 7 and decreased to 182.5 seconds±87.8 (n = 6; P = .0342) by day 90. The mean IELT remained at 182.5 seconds±27.6 at day 180 (n = 23; P<.0001) and decreased to 140.9 seconds±83.6 by 1 year (n = 22; P<.001). PEP scores improved overall, IELTs significantly improved at 180 and 360 days, and 83% of subjects reported that they would undergo the procedure again if given the same opportunity. There were no procedure-related complications.ConclusionsCT-guided percutaneous unilateral cryoablation of the DPN is a feasible, safe, single-day outpatient procedure for the treatment of symptomatic PE.     

儿童股骨头缺血性坏死的介入治疗

儿童股骨头缺血性坏死致残率极高 ,发病原因多为 :①先天性发育不良 ;②外伤 ;③应用激素等。我院自 1992年以来 ,开展了经股动脉穿刺插管至旋股内、外侧动脉及闭孔动脉直接给药治疗股骨头缺血性坏死的介入性治疗[1～ 3] ,现将资料完整的3 0例患者总结报告如下。1　资料与方法1.1　一般资料　 3 0例患者中 ,男 9例 ,女 2 1例 ,年龄 4～ 14岁 ,平均 9岁。其中双侧病变 2例 ,单侧病变 2 8例 (左侧 13例 ,右侧 15例 ) ,病程 0 .5～ 2年。全部病例在介入治疗前及治疗后摄双髋关节平片检查 ,ＣＴ检查 15例[4 ] ,ＭＲＩ检查 6例 ,诊断结果明确。行…     

大肠癌肝转移机制及诊治进展

近年来随着人们生活水平的普遍提高,大肠癌的发病率在我国乃至全球范围内都有明显上升的趋势.在西方国家,大肠癌是癌症死亡的第二位原因,大约有1/4的大肠癌患者在确诊时发现已存在肝脏转移灶,而肝转移是晚期大肠癌患者的最主要死因.对大肠癌肝转移机制的研究,可能为临床诊治及提高患者生活质量,延长生存期提供新的线索.     

Percutaneous Image-Guided Cryoablation for the Treatment of Phantom Limb Pain in Amputees: A Pilot Study

PurposeTo prospectively evaluate percutaneous image-guided nerve cryoablation for treatment of refractory phantom limb pain (PLP) in a pilot cohort for purposes of deriving parameters to design a larger, randomized, parallel-armed, controlled trial.Materials and MethodsFrom January 2015 to January 2016, 21 patients with refractory PLP underwent image-guided percutaneous cryoneurolysis procedures. Visual analog scale scores were documented at baseline and 7, 45, and 180 days after the procedure. Responses to a modified Roland Morris Disability Questionnaire were documented at baseline and 7 and 45 days after the procedure.ResultsTechnical success rate of the procedures was 100%. There were 6 (29%) minor procedure-related complications. Disability scores decreased from a baseline mean of 11.3 to 3.3 at 45-day follow-up (95% confidence interval 5.8, 10.3; P < .0001). Pain intensity scores decreased from a baseline mean of 6.2 to 2.0 at long-term follow-up (95% confidence interval 2.8, 5.6; P < .0001).ConclusionsImage-guided percutaneous nerve cryoablation is feasible and safe and may represent a new efficacious therapeutic option for patients with phantom pains related to limb loss.