CT联合C臂机引导下椎体成形术在中上段胸椎骨质疏松性椎体压缩骨折中的应用

Clinical application of percutaneous vertebroplasty guided by CT and Carm fluoroscopy in the treatment of upper thoracic osteoporotic vertebral compression fractures

目的探讨CT联合C臂机引导下椎体成形术治疗中上段胸椎骨质疏松性椎体压缩骨折的临床效果及注意事项。方法回顾性分析2010年7月~2013年12月于武警山东省总队医院行CT联合C臂机引导下椎体成形术的30例中上段胸椎压缩骨折患者的临床资料,其中伤椎30个：T41例,T54例,T64例,T78例,T813例。手术前、后对所有患者进行视觉模拟疼痛评分（VAS）及Oswestry功能障碍指数（ODI）评价腰背部功能状况。结果所有患者均获得随访,随访时间为6~15个月,平均12个月。穿刺成功率为100%,1年内出现相邻椎体骨折1例,再次行椎体成形术;2例发生椎旁软组织无症状性骨水泥渗漏;无气胸、肋骨骨折、肺动脉栓塞等严重并发症发生。术后1 d、1周和1、3、6个月患者VAS评分、ODI指数与术前比较,差异均有统计学意义（P〈0.05）。结论 CT引导穿刺的精确性结合C臂透视的实时性可以克服中上段胸椎解剖结构的特殊性,降低了穿刺操作的难度和骨水泥注射的风险,值得临床推广。

Objective To evaluate the clinical effect and the matters needing attention of percutaneous vertebroplasty guided by CT and C-arm fluoroscopy in the treatment of upper thoracic osteoporotic vertebral compression fractures. Methods 30 patients with upper thoracic osteoporotic vertebral compression fractured treated by percutaneous vertebroplasty guided by CT and C-arm fluoroscopy from July 2010 to December 2013 in Armed Police Shandong General Team Hospital were retrospectively analyzed. There were 30 injured vertebral, they were T4 in 1 case, Ts in 4 cases, T6 in 4 cases, T7 in 8 cases, Ts in 13 cases. Visual analogue scale （VAS） and Oswestry disability index （ODI） were used to evaluate the degree of pain and function of the small of the back in the preoperative and postoperative. Results All pa- tients were followed up completely, from 6 months to 15 months （an average of 12 months）. The puncture for all verte- bral bodies was successful at one time. 1 patient occurred new fracture in the adjacent vertebrae within 12 months, and was given the vertebroplasty once again. Asymptomatic Bone cement leakage to the paravertebral soft tissues in 2 cases, but no associated clinical symptoms occurred. No other serious complications such as pneumothorax, rib fracture, pulmonary embolism was found. Compared with the preoperative, VAS and ODI showed statistically significant differ- ences at 1 day, 1 week, and 1,3,6 months postoperatively （P 〈 0.05）. Conclusion The accuracy of CT and the real-time of C-arm fluoroscopy can overcome the particularity of upper-middle thoracic anatomic structure. Reducing the diffi- culty of the piercing operation and the risk of bone cement injection. It is worthy of clinical application.