改良影像导航引导椎体后凸成形术在治疗多发性椎体压缩性骨折中的应用

Percutaneous kyphoplasty guided by modified imaging-assisted navigation for the treatment of multiple osteoporotic spinal compression fracture

目的:探讨改良影像导航方法引导椎体后凸成形术治疗多发性椎体压缩性骨折的临床意义。方法:2006年1月至2009年10月在本科就诊的32例患者的81个椎体骨质疏松性压缩骨折,获取手术椎节的正侧位及斜位X线影像,通过影像导航模拟手术椎体的正侧位及椎弓根轴位虚拟影像,引导经皮椎弓根穿刺行椎体后凸成形术。术后复查X线片、CT检查了解骨折椎体骨水泥分布及外漏情况,观察手术前后视觉类比评分(VAS)的变化。结果:本组32例患者均为单侧穿刺,通过影像导航引导椎弓根穿刺均获成功。术中进行导航虚拟影像与实际穿刺针影像进行匹配,两者影像基本吻合。PMMA的注射量为2.5～5 mL,术后X线、CT复查显示PMMA填充良好。术前VAS平均(7.5±1.5)分,术后48 h平均(3.0±0.5)分,P<0.05。32例平均随访(9±3)个月,疼痛缓解效果均得到稳定维持,无椎体塌陷。结论:通过改良影像导航模拟椎体三维影像引导椎体后凸成形术,可提高手术精确度,减少骨水泥渗漏发生,并可对多个椎体进行定位手术,减少手术时间和术中辐射暴露时间。

Objective：To explore the clinical significance of percutaneous kyphoplasty guided by modified imaging-assisted navigation for the treatment of multiple osteoporotic spinal compression fracture. Methods ： The 81 affected vertebras were obtained from 32 patients with muhiple osteoporotic spinal compression fracture who were recruited from department of spinal surgery, Guangzhou First People＇ s Hospital, between January 2006 and October 2009. Anterior-posterior, lateral and oblique radiography of the affected vertebra was obtained for subsequent guidance of pereutaneous kyphoplasty by virtual images generated by imaging-assisted navigation technique. The X-ray and CT examinations were undertaken postoperatively to determine the vertebral bone cement distribution and leakage condition and the changes in visual analogue scale （VAS） prior to and following the surgery. Results： The 32 patients who received unilateral puncture for the treatment of pereutaneous kyphoplasty tolerated the imaging-assisted navigation well. The virtual images generated by imaging-assisted navigation resembled those by puncture needle. The PMMA, when administered at a dose of 2.5 to 5 ml, was satisfactorily filled in the affected sides, as was confirmed by X-ray and CT postoperatively. The surgery resulted in a dramatic reduction in VAS （ [ 7.5 ±1.53 vs. [ 3.0±0. 53, P 〈 0. 05 ） at hour 48. Following a mean of （9 ± 3 ） months, the pain was well attenuated and no vertebral compression was reported. Conclusion： Percutaneous kyphoplasty guided by three-dimensional virtual images generated by imaging-assisted navigation system may improve precision of surgery, reduce the incidence of bone cement leakage and may operate at multiple vertebras, thus reducing the time for surgery and exposure to radiation.