CT图像模拟穿刺路径在经皮椎体成形术中的应用价值

Application of puncture simulation using preoperative CT for unilateral transpedicular approach on percutaneous vertebroplasty

目的:探讨CT图像模拟穿刺路径在单侧椎弓根入路经皮椎体成形术(PVP)中的应用价值。方法:45例(61个椎体)患者术前均行CT检查,在CT图像上测量模拟经皮椎体成形术穿刺角度及旁开棘突距离,并在此参数参考下,于X线透视下行经皮椎体成形术。采用视觉模拟评分法(VAS评分)和WHO评分法评价疼痛缓解情况。结果:不同节段椎体穿刺角度及棘突旁开距离差异有统计学意义(P<0.05),Th8～L5椎体穿刺角度及旁开距离逐渐增大。本组手术成功率100%,术后疼痛缓解率为100%。单侧椎弓根穿刺成功率为95.1%。结论:对于不同节段椎体,PVP手术穿刺角度及穿刺点选择是不同的,术前根据CT图像测量穿刺参数可有效提高单侧椎弓根穿刺成功率。

Objective：The aim of this study was to study the feasibility of puncture simulation method using preoperative CT for unilateral transpedicular approach on percutaneous vertebroplasty（PVP）.Methods：Before therapy,45 patients（61 vertebral bodies） performed CT and MRI scanning.The puncture angle and skin needle entry point were measured by preoperative puncture simulation on the CT image.PVP procedure was accomplished under C arm based on the measurement results.The effect of pain relief was determined by visual analogue score and WHO standard.The statistical analysis used SPSS 13.0 statistical software.Dates were shown as the mean±standard deviation.Results：The measurement results showed significant differences in the puncture angle and skin needle entry point for different vertebral body（P〈0.01）.There was a rise on puncture angle and skin needle entry points from Th8 to L5.The procedures were successful in all patients.After PVP,complete relief of pain was achieved in all patients.The success rate of uilateral transpedicular approach was 95.1%.Conclusion：The puncture angle and skin needle entry point are different for different vertebral body.The preoperative parameters determination can increase the completion rate of PVP using the unilateral transpedicular approach.