C型臂引导下经皮穿刺活检术在骨骼系统病变诊断中的应用

Application of C-arm guided percutaneous puncture biopsy in diagnosis of skeletal system

目的探讨C型臂引导下骨骼系统病变经皮穿刺活检的方法、成功率、准确率及临床应用价值。方法于郑州大学第一附属医院接受C型臂引导下骨骼系统病变经皮穿刺穿刺活检的患者共计56例,男性27例,女性29例,年龄7~79岁,平均43.21岁,操作均由同一位高年资医师完成。病变部位脊柱28例,附肢骨28例,所有患者术前均进行了病变部位的X线、CT和(或)MRI等检查,其中12例患者接受了SPECT检查,均未得出明确诊断。选择合适体位,在C型臂引导下对病变目标位置沿既定方向进行穿刺取材,将取出的标本用10%福尔马林固定后送病理科检查。结果 56例患者均成功取材,穿刺取材成功率100%。54例标本获得明确病理诊断,活检病理阳性率96.43%(54/56)。51例与最终临床诊断相符,活检病理诊断准确率91.07%(51/56)。手术时间5~30 min,C型臂曝光1~8次,出血量3~15 ml,均无操作相关并发症发生。结论 C型臂引导下经皮穿刺骨骼活检术,穿刺成功率高,诊断准确率高,并且具有操作简单、快捷,术中出血少、辐射暴露短等优点,是一种简单、可靠的术前诊断手段,尤其是在目前提倡分级诊疗、合理配置利用医疗资源的形势下,值得推广应用。

Objective To explore the method,success rate,accuracy and clinical value of C-arm guided percutaneous puncture biopsy of skeletal system. Methods A total of 56 patients(27 males and 29 females,aged 7-79 years）,with an average age of 43. 21 years,underwent C-arm guided percutaneous puncture biopsy of skeletal system. All the operations were done by the same senior surgeon. The lesions were found in the spine(28 cases） and appendicular skeleton(28 cases）. Preoperative examinations including X-ray,CT,MRI and other tests were conducted in all patients,and in which 12 patients received SPECT examination with no clear diagnosis. The puncture biopsy was performed in the target position of the lesion guided by C-arm. The specimen was fixed with 10% formalin and examined by pathology technique. Results All 56 patients were punctured successfully. 100% of the puncture samples were qualified. Histopathological results were obtained in 54 patients,and the positive rate of biopsy was 96. 43%(54/56）. 51 cases were consistent with the final clinical diagnosis,and accuracy of the biopsy diagnosis reach 91. 07%(51/56）. Operation time 5-30 minutes,C-arm exposure 1-8 times,amount of bleeding 3 ~ 15 ml,no operation-related complications occurred. Conclusion C-arm guided percutaneous bone biopsy has high success rate and high diagnostic accuracy.Besides,this method has advantages of simple and quick operation,less intraoperative bleeding,less radiation exposure and so on. It is a simple and reliable preoperative diagnostic mean. Therefore,it is worth promoting the application,especially in the current situation of advocating hierarchical diagnosis and treatment,rational allocation and effective use of medical resources.