腰椎QCT与骨质疏松性胸腰椎骨折伤椎骨造影弥散度的关联性

Relationship between the lumbar quantitative computed tomography values and contrast agent dispersion in osteoporotic thoracolumbar fractures

背景:骨质疏松性胸腰椎骨折目前临床通常采用经皮穿刺椎体成形术治疗,该术式具有操作难度不大,手术时间短,创伤较小,康复快,止痛疗效确切等多项优点,但其存在骨水泥渗漏而引起的神经压迫症状甚至肺栓塞等并发症,制约其发展。如何降低骨水泥的渗漏,是目前研究的热点。目的:分析腰椎QCT值与骨质疏松性胸腰椎骨折伤椎对比剂的弥散分布的关联性。方法:选取60例行经皮穿刺椎体成形术治疗的骨质疏松性胸腰椎骨折患者,术前行腰椎QCT检查,术中往椎体内注射对比剂,正侧位C臂X光机透视,了解不同骨密度值患者对比剂弥散分布情况以及骨水泥在椎体内弥散分布及渗漏等情况,分析腰椎QCT值与伤椎对比剂弥散分布及骨水泥渗漏的关联性。结果与结论:(1)60例共110个伤椎中对比剂弥散超过椎体中线74椎,占67.3%。低骨量组、骨质疏松组、严重骨质疏松组各组间对比剂弥散度比较差异有统计学意义(P<0.05);(2)经单侧或双侧入路椎体成形式注入骨水泥,不同骨密度患者组间骨水泥渗漏情况比较无显著差异(P>0.05)。(3)结果显示,对比剂在骨质疏松性胸腰椎骨折伤椎中的弥散分布与腰椎QCT值有一定关系,QCT值低的患者比QCT值较高的患者伤椎对比剂弥漫分布更充分,但骨水泥渗漏的发生与QCT值高低无明显相关,说明根据QCT值结合对比剂分布选择不同穿刺术式伤椎注入骨水泥可减少其渗漏,提高椎体成形术的安全性。

BACKGROUND： Percutaneous vertebroplasty （PVP） is usually used for osteoporotic thoracolumbar fractures,which has various advantages such as easy to operate, short operation time, less trauma, rapid recovery,analgesic effect and so on. But its application is restricted due to nerve compression symptoms and pulmonary embolism caused by bone cement leakage. Thereafter, how to reduce the leakage of bone cement is an issue of concern.OBJECTIVE： To investigate the relationship between the lumbar quantitative computed tomography （QCT） values and contrast agent dispersion in osteoporotic thoracolumbar fractures. METHODS： Sixty cases of osteoporotic thoracolumbar fractures undergoing PVP were enrolled, and received QCT examination before surgery, and contrast agent was injected intraoperatively. X-ray examination was conducted to detect the bone mineral density, contrast agent dispersion and leakage of bone cement, and the relationship between the lumbar QCT values and contrast agent dispersion as well as leakage of bone cement.RESULTS AND CONCLUSION： （1） There were 110 vertebral fractures, and 74 vertebrae with contrast agent diffusing more than vertebral midline, accounting for 67.3%. There was significant difference in the contrast agent dispersion among groups （P 〈 0.05）. （2） The bone cement leakage showed no significant difference among groups after injected with bone cement by unilateral or bilateral approach （P 〉 0.05）. （3） These results suggest that contrast agent dispersion in osteoporotic thoracolumbar fractures has a certain relationship with the lumbar QCT values, and lumbar QCT values with more contrast agent dispersion, but the lumbar QCT values have no correlation with bone cement leakage. Therefore, choosing a appropriate approach based on the QCT values and contrast agent dispersion can reduce leakage and improve the safety of PVP.