计算机导航辅助下经皮椎体成形术

Computer imaging-guided percutaneous vertebroplasty

目的探讨红外线透视导航下经皮椎体成形术治疗骨质疏松性压缩骨折的方法和疗效。方法采用红外线透视导航下经皮椎体成形术治疗骨质疏松性压缩骨折22例(32椎),骨折部位为T6～L4,胸椎14椎,腰椎18椎。压缩程度为20%～90%,其中5例椎体压缩在75%以上。12椎行椎体成形术;20椎行椎体后凸成形术,其中12椎行球囊扩张成形,8椎行sky膨胀式椎体成形。行单椎体注射14例,两椎体注射6例,三椎体注射2例;18椎采用单侧椎弓根注射,14椎采用双侧椎弓根注射。术后行X线及CT检查了解骨折椎体复位情况、椎体容量变化、骨水泥分布及外漏情况,用CT容量分析法观测手术前后椎体的容积变化,观察手术前后疼痛强度评价的直觉模拟评分变化。结果成功对32椎注射骨水泥,无手术中死亡病例,无神经根及脊髓受压,无肺栓塞及心脑血管系统急性反应。每椎手术时间为(18.4±4.5)min,X线照射剂量为(12.2±3.4)dGy,注射骨水泥量为(4.4±2.5)ml,椎体体积由术前的(22.2±8.6)cm3增至术后的(24.8±6.9)cm3,容积变化手术前后差异有统计学意义(P<0.05)。VAS由术前的(8.3±1.6)分下降为术后48h的(2.2±3.7)分,差异有统计学意义(P<0.05)。术后平均随访10(6～16)个月,无严重并发症,无椎体塌陷。结论采用导航系统引导行椎体成形术能明显提高手术精确度和安全性,减少放射线剂量,缩短手术时间,并扩大了手术适应证。

Objective To study the method and clinical results of Infrared Fluoroscopic Navigation Guiding system guided percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures. Methods Twenty-two cases with 32 osteoporotic vertebral compression fractures underwent percutaneous vertebroplasty guided by Infrared Fluoroscopic Navigation Guiding system. The fracture segment was within T6-L4 （14 thoracical vertebrae, 18 lumbarver vertebrae）. The compression ratio was from 20% to 90% in which 5 vertebral bodies were 75%. 12 vertebral bodies underwent PVP, and 20 vertebral bodies underwent PKP in which balloon expansion were used in 12 vertebral bodies and sky expansion were used in 8 vertebral bodies. Single vertebral body injection were in 14 cases, two vertebral body injection were in 6 cases, three vertebral body injection were in 2 cases including 18 vertebral bodies injection via unilateral pedicle of vertebral arch and 14 vertebral bodies injection via bilateral pedicle of vertebral arch. Restoration of vertebra height and cement leakage was observed by postoperative X-ray and CT scan. Changes of preoperative and postoperative vertebral body volume measured by CT volumetry was compared. Preoperative and postoperative Vasual analogue scale （VAS） score was compared. Results PVP was successful in 22 cases with 32 vertebral bodies. No nerve and spinal cord damage, lung embolism and heart and brain vessel acute reaction occurred. Operative time was （18.4±4.5） mins per vertebral body. X-ray dosage was （12.2±3.4） dGy per vertebrae. The amount of bone cement was （4.4±2.5） ml per vertebrae. The vertebral body volume was improved from preoperative （22.2±8.6） cm^3 to postoperative （24.8±6.9） cm^3 with a significant differences （P〈 0.05）. VAS score descended from preoperative 8.3±1.6 to postoperative 2.2±3.7 with a significant difference （P〈0.05）, No serious syndrome and vertebral body collapse was found after follow-up of mean 8 months （6- 16 months）. Conclusion Using Infrared Fluoroscopic Navigation Guiding percutaneous vertebroplasty can improve operative precision and security distinctively, reduce X-ray irradiation dosage, shorten operative time and extend operative adaptability.