Mimics软件评估椎体成形中骨水泥的安全剂量

Safety dose of bone cement in vertebroplasty assessed by Mimics software

背景:随着骨质疏松椎体压缩性骨折患者日渐增多,经皮穿刺椎体后凸成形治疗究竟给予多少骨水泥,目前临床上难以达成一致意见。目的:采用Mimics软件评估骨质疏松椎体压缩性骨折椎体成形术中不同骨水泥注射剂量与患者临床疗效、骨水泥渗漏的关系,探索椎体成形安全、有效的骨水泥注射量。方法:纳入经皮穿刺椎体后凸成形治疗的胸腰椎骨质疏松椎体压缩性骨折患者43例,随机分为2组。利用Mimics软件术前设计注入椎体的骨水泥量及椎体体积,按骨折椎体上下椎体体积平均值计算骨水泥体积比,A、B组按照多数文献认可的骨水泥体积比(骨水泥量/椎体体积比),分别注入24%及15%的骨水泥。随访评估两组在疼痛、渗漏率、Cobb’s角及再骨折发生率方面的差异。结果与结论:①所有患者获6-24个月随访;②目测类比评分:两组患者术后各时点与术前相比,术后第1天与术后第5天(出院前)、3个月、12个月相比,差异均有显著性意义(P <0.05);两组之间术后各时点疼痛程度比较,差异均无显著性意义(P> 0.05);③A组共5例出现渗漏(24%),B组共2例出现渗漏(10%),两组骨水泥渗漏率之间差异无显著性意义(P> 0.05);④骨折椎体Cobb’s角方面:两组术前Cobb’s角与术后不同时点相比,差异均有显著性意义(P <0.05);两组之间术后第5天、3个月、12个月相比,差异均无显著性意义(P> 0.05);⑤A组发生3例再骨折(14%),B组发生2例再骨折(10%),两组间椎体再骨折方面差异无显著性意义(P> 0.05);⑥提示运用Mimics软件术前评估骨水泥量较精准,按骨水泥量/椎体体积比15%及24%注射骨水泥量适中,并发症少,近期临床疗效满意。

BACKGROUND: With the increasing number of osteoporosis vertebrae compression fracture patients, it is difficult to reach a consensus on how much bone cement is given in percutaneous kyphoplasty surgery. OBJECTIVE: To investigate the relationship of different doses of bone cement with clinical efficacy and bone cement leakage using Mimics software, and to explore the safe and effective bone cement injection threshold in percutaneous kyphoplasty for cases with osteoporosis vertebrae compression fracture. METHODS: Forty-three patients with osteoporosis vertebrae compression fracture undergoing percutaneous kyphoplasty were included and randomly divided into two groups. The amount of bone cement injected into the vertebral body and the volume of vertebral body were designed by Mimics software. The volume ratio of bone cement was calculated according to the average volume of upper and lower vertebrae. In groups A and B, 24% and 15% of bone cement were injected according to the bone cement volume ratio(bone cement volume/vertebral volume ratio) recognized by most documents. The differences of pain, leakage rate, Cobb’s angle and refracture rate between the two groups were evaluated by follow-up.RESULTS AND CONCLUSION:(1) All patients were followed up for 6-24 months.(2) There were significant differences in visual analogue scale score between the two groups between preoperation and at each time point after operation, the first day after operation and the fifth day(before discharge), three months and 12 months after operation(P < 0.05). There was no significant difference in pain degree between the two groups at each time point after surgery(P > 0.05).(3) There were 5 cases(24%) with leakage in group A and 2 cases(10%) in group B;there was no significant difference in the leakage rate of bone cement between the two groups(P > 0.05).(4) There were significant differences in Cobb’s angle between the two groups between different time points after operation and preoperation(P < 0.05). There was no significant difference between the two groups at 5 days, 3 months and 12 months after operation(P > 0.05).(5) There were 3 cases of refracture in group A(14%) and 2 cases in group B(10%). There was no significant difference between the two groups(P > 0.05).(6) Above results confirm that it was accurate for us to evaluate bone cement volume according to the fracture vertebral body volume by 15% and 24% injection of bone cement using Mimics software, which showed less complications and short-term satisfactory clinical efficacy.