经皮椎体后凸成形术治疗椎体转移瘤中C臂CT的临床应用

Clinical application of C- arm CT in percutaneous kyphoplasty due to vertebral metastases

目的探讨经皮椎体后凸成形术（PKP）治疗椎体转移瘤中C臂CT的应用价值。方法分析2009年8月--2013年8月行PKP治疗的伴有不同程度胸、腰背部疼痛的椎体转移瘤患者69例。所有患者行PKP前均行C臂CT检查，指导制订椎体穿刺计划；术中结合X线透视和C臂CT保证椎体穿刺及活检准确性；术后立即使用C臂CT检查评估骨水泥渗漏情况；术后3—5d根据WHO标准疼痛疗效评价及视觉模拟评分（VAS）变化评估PKP镇痛疗效。对VAS评分变化使用配对t检验进行统计学分析（P〈0．05）（SPSSl9统计学软件）。结果①共对154个骨转移椎体进行治疗，穿刺均获成功。②对50例患者的93个椎体行椎体穿刺活检，59个椎体获得阳性病理诊断，椎体活检阳性率63．4％。③术后C臂CT检查共发现67个椎体发生骨水泥渗漏，渗漏发生率为43．5％。④据WHO标准疼痛疗效评价，有效率为76．8％；患者术前VAS疼痛评分为6．9±1．6分，术后VAS疼痛评分为3．0±2．3分。患者术前、术后疼痛评分有显著统计学差异（P〈0．01）。结论C臂CT在PKP前可指导制订椎体转移瘤穿刺计划，术中可引导准确穿刺及活检，术后可及时、可靠地评估骨水泥渗漏。

[Abstract] Objective To evaluate the clinical application of C-arm CT in percutaneous kyphoplasty for the treatment of vertebral metastases. Methods During the period from Aug. 2009 to Aug. 2013, a total of 69 patients with different degree of chest, waist and back pain caused by vertebral metastases were admitted to authors＇ hospital to receive percutaneous kyphoplasty. Before the operation C- arm CT was performed for every patient in order to make proper vertebral puncturing plan. During the procedure C- arm CT together with X- ray fluoroscopy was employed to ensure a correct vertebral puncturing and biopsy. Immediately after the surgery, C-arm CT was performed to check the bone cement leakage. According to WHO standard of curative effect and visual analogue scale （VAS） changes, the anti- pain effect of percutaneous kyphoplasty was evaluated. The changes of VAS scores were statistically analyzed by using paired t- test. Results A total of 154 vertebral metastases were treated. Unilateral pedicle puncturing was carried out in 137 vertebral bodies, while bilateral pedicle puncturing was performed in 17 vertebral bodies. All punctures were successfully accomplished. Puncture biopsy was conducted for 93 vertebral bodies of 50 patients, with a positive rate of 63.4%. Postoperative C- arm CT examination showed that bone cement leakage was found in 67 vertebral bodies, with a leakage rate of 43.5%. According to WHO standard of pain assessment, the effective rate was 76.8%. The preoperative and postoperative VAS scores were （6.9 ＋ 1.6） and （3 _＋ 2.3） respectively, and the difference between the two was statistically significant （P 〈 0.01 ）. Conclusion For the treatment of vertebral metastases, C- arm CT can help make vertebral puncturing plan before percutaneous kyphoplasty, correctly guide puncturing and biopsy during the operation, and timely and reliably assess the bone cement leakage after the surgery. （J Intervent Radiol, 2014, 23 ： 167-171）