C型臂下联合应用骨活检针和活检钳经椎弓根穿刺椎体活检在脊柱病变诊断中的价值

Value of C-arm guided transpedicular vertebral puncture biopsy with biopsy needle and forceps in diagnosing spinal diseases

目的探讨C型臂下联合应用骨活检针和活检钳经椎弓根穿刺椎体活检在脊柱病变诊断中的价值。方法选择2013年1月至2015年12月珠海市人民医院收治的胸腰椎椎体病变患者58例,均行C型臂下经椎弓根穿刺椎体活检,其中单纯应用骨活检针29例(对照组),联合应用骨活检针和活检钳29例(观察组),对2组患者穿刺及病理结果进行比较。结果 2组58例患者均穿刺成功,术中均未见神经、血管及周围器官损伤等穿刺相关的并发症。对照组患者手术时间为(27.3±3.1)min,出血量为(7.0±1.5)m L;观察组患者手术时间为(26.2±2.5)min,出血量为(6.8±1.4)m L;2组患者手术时间及出血量比较差异均无统计学意义(P>0.05)。对照组患者活检取材成功率为72.4%(21/29),组织病理阳性率为71.4%(15/21),手术病理阳性率为51.4%(15/29);观察组患者活检取材成功率为96.6%(28/29),组织病理阳性率为96.4%(27/28),手术病理阳性率为93.2%(27/29);观察组患者活检取材成功率、组织病理阳性率和手术病理阳性率均显著高于对照组(P<0.05)。结论 C型臂下经椎弓根穿刺椎体活检安全有效,联合应用骨活检针和活检钳可显著提高取材成功率和病理阳性率,且不增加手术时间和出血量。

Objective To evaluate the value of C-arm guided transpedicular vertebral puncture biopsy with biopsy needle and forceps in diagnosing spinal diseases. Methods Fifty-eight patients with thoracolumbar vertebral lesions were selected in the People＇s Hospital of Zhuhai City from January 2013 to December 2015. All patients received transpedicular vertebral puncture biopsy guided by C-arm,in which 29 cases（ control group） were performed with biopsy needle,29 cases（ observation group） were performed with biopsy needle and biopsy forceps. The results of puncture and pathological examination were compared between the two groups. Results The punctures in fifty-eight patients were successful,there was no intraoperative nerve,blood vessels and peripheral organ damage and other puncture related complications. The operation time was（ 27. 3 ±3. 1） min,and the bleeding was（ 7. 0 ± 1. 5） m L in control group. The operation time was（ 26. 2 ± 2. 5） min,and the bleeding was（ 6. 8 ± 1. 4） m L in observation group. There was no significant difference in the operation time and bleeding between the two groups（ P 0. 05）. The successful rate of biopsy was 72. 4%（ 21 /29）,the positive rate of histopathology was 71. 4%（ 15 /21）,the positive rate surgical pathology was 51. 4%（ 15 /29） in control group. The successful rate of biopsy was 96. 6%（ 28 /29）,the positive rate of histopathology was 96. 4%（ 27 /28）,the positive rate surgical pathology was 93. 2%（ 27 /29） in observation group. The successful rate of biopsy,positive rate of histopathology and surgical pathology in observation group were significantly higher than those in control group（ P 0. 05）. Conclusion C-arm guided transpedicular vertebral puncture biopsy is secure and effective,and combined use of biopsy needle and biopsy forceps can significantly improve the success rate of puncture and pathological positive rate,also don＇t increase the operation time and bleeding.