基于Mimics软件分析椎体成形术后骨水泥形态和弥散程度的临床意义

Bone cement distribution form and diffusion degree after percutaneous vertebroplasty: an analysis based on Mimics software and its clinical significance

背景:有研究发现,骨水泥分布形态及弥散程度是影响椎体成形术临床疗效的主要因素。目的:探讨Mimics软件分析骨水泥形态和弥散程度的可行性,以及骨水泥形态和弥散程度与临床疗效的关系。方法:纳入2017年1月至2018年3月自贡市第四人民医院收治的骨质疏松性椎体压缩骨折患者170例,其中男41例,女129例,年龄60-97岁,均进行骨水泥椎体成形术治疗。术后2d进行X射线与CT检查,依据X射线中骨水泥分布分为4组,分别为Ⅰ型(大部分骨水泥连续、均匀分布在椎体内)、Ⅱ型(大部分骨水泥分布在椎体中央区)、Ⅲ型(大部分骨水泥分布在椎体两侧)、Ⅳ型(大部分骨水泥分布在椎体一侧及中央)、Ⅴ型(大部分骨水泥分布在椎体一侧)型;依据CT影像资料创建Mimics项目文件,计算骨水泥体积与弥散体积;术后随访6个月,对比各组目测类比评分、Oswestry功能障碍指数与Cobb角,分析骨水泥分布形态、骨水泥弥散体积、骨水泥弥散体积比与临床疗效之间的关系。结果与结论:(1)术后2 d、6个月,5种形态骨水泥组目测类比评分、Oswestry功能障碍指数均较术前明显改善(P <0.05),Ⅰ型组Cobb角较术前明显改善(P <0.05),Ⅱ-Ⅴ型组Cobb角与术前比较无差异(P> 0.05);(2)骨水泥弥散体积为(6.69±1.19) mL,骨水泥弥散体积比为(20.93±3.13)%;骨水泥注入量与术后2 d、术后6个月的目测类比评分、Oswestry功能障碍指数、Cobb角间不存在关联性,骨水泥弥散体积与术后6个月的目测类比评分、术后2 d和术后6个月的Oswestry功能障碍指数评分间存在负相关(P <0.05),但关联性弱;骨水泥弥散体积比与术后2d、术后6个月的目测类比评分、Oswestry功能障碍指数评分间存在负相关(P<0.05),关联性强;(3)结果表明,基于Mimics软件的三维重建功能,能准确计算骨水泥弥散体积及弥散体积比,如骨水泥分布形态均匀良好,更能缓解局部后凸角;骨水泥弥散体积比与临床疗效呈正相关,较骨水泥体积更有临床价值。

BACKGROUND:It has been found that the distribution and diffusion degree of bone cement are the main factors influencing the clinical effect of percutaneous vertebroplasty.OBJECTIVE:To explore the feasibility of analyzing bone cement distribution form and diffusion degree based on Mimics software,and to evaluate the relationship of clinical efficacy with bone cement distribution form and diffusion degree.METHODS:A total of 170 cases of osteoporotic vertebral compression fracture admitted to Zigong No.4 People’s Hospital from January 2017 to March 2018 were included,including 41 cases of males and 129 cases of females aged 60-97 years.All of them were treated with percutaneous vertebroplasty.X-ray and CT examination were done at postoperative 2 days,and the bone cement distribution was classified into five types based on the distribution of bone cement in X-ray images,including type I(most cement continuously and evenly distributed in the vertebral body),type II(most cement distributed in the central vertebral bodies),type III(most cement distributed on both sides of vertebral body),type IV(most cement distribution at the side of the vertebral bodies and the central),type V(most cement distribution at the side of the vertebral body).Mimics project files were created based on CT image data to calculate bone cement volume and diffusion volume.After 6 months of follow-up,visual analogue scale score,Oswestry disability index and Cobb angle were compared among groups to analyze the relationship between bone cement distribution,bone cement diffusion volume,bone cement diffusion volume ratio and clinical efficacy.RESULTS AND CONCLUSION:(1)The visual analogue scale score and Oswestry disability index of the five types of bone cements were significantly improved at 2 days and 6 months after surgery compared with preoperative data(P<0.05),the Cobb angle of the type I group was significantly improved compared with preoperative data(P<0.05),and the Cobb angles of the type II-V groups showed no difference from the preoperative data(P>0.05).(2)The diffusion volume of bone cement was(6.69±1.19)mL,and the diffusion volume ratio of bone cement was(20.93±3.13)%.There was no correlation between the volume of bone cement injection and the visual analogue scale score,Oswestry disability index and Cobb angle at 2 days and 6 months after surgery.There was a negative correlation between the bone cement dispersion volume and the visual analogue scale score at 6 months after surgery,and the Oswestry disability index score at 2 days and 6 months after surgery(P<0.05),but the correlation was weak.The diffusion volume ratio of bone cement was negatively correlated with the visual analogue scale score and Oswestry disability index score at 2 days and 6 months after surgery(P<0.05),showing a strong correlation.These findings show that,based on the three-dimensional reconstruction function of Mimics software,the diffusion volume and diffusion volume ratio of bone cement can be accurately calculated.The bone cement evenly distributed can alleviate the local kyphosis.The diffusion volume ratio of bone cement is positively correlated with clinical efficacy,which is more valuable than the volume of bone cement.