CT图像模拟穿刺路径运用于经皮椎体成形术的临床研究

Clinical Study on the Application of Simulated Puncture Pathway on CT Images in Percutaneous Vertebroplasty

目的探讨CT图像模拟穿刺路径在经皮椎体成形术(PVP)中的临床应用。方法选取2020年2月至2022年1月本院收治的胸腰椎骨质疏松伴有病理性或压缩性骨折的患者30例,均行术前病椎水平面CT扫描检查,在CT图像上测量拟PVP穿刺角度及旁开棘突的距离,采集数据并作为参数,在X线透视下行PVP。观察治疗效果,采用美国脊髓损伤协会(ASIA)量表评价患者的神经功能情况,并对手术的安全性进行评价。结果不同椎体穿刺角度以及棘突旁开距离差异有统计学意义(F=69.850、105.23,P<0.05),且T_(8)~L_(5)椎体穿刺及旁开距离逐渐增大。所有患者均手术顺利,一针穿刺成功率为100.00%(30/30),单侧入路成功率为93.33%(28/30),手术时间为25~38(30.25±3.00)min,骨水泥注入量为1.69~5.23(3.85±1.22)mL。与术前相比,术后1个月、6个月的椎体高度均较术前提高(t=20.266、17.887,P<0.05),术后1个月、6个月的Cobb角均较术前降低(t=24.932、22.159,P<0.05)。与术前相比,术后1个月、6个月的ASIA评分均较术前提高(t=69.763、76.681,P<0.05)。所有患者术后第1日复查CT或X线片,显示骨水泥沉积良好,所有患者在6个月的随访内均未出现并发症。结论CT图像模拟穿刺路径可提高PVP手术的穿刺成功率,促进患者康复。

Objective To explore the clinical application value of CT image simulation puncture pathway in percutaneous vertebroplasty(PVP).Methods From February 2020 to January 2022,30 patients with thoracolumbar osteoporosis accompanied by pathological or compressibility fractures admitted to our hospital were selected.All patients underwent preoperative horizontal CT scanning of the diseased vertebrae.The puncture angle of the proposed PVP and the distance of the paraspinal process were measured on the CT image,and the data were collected as parameters.PVP was performed under X-ray fluoroscopy.Observe the postoperative treatment effect,evaluate the patient's neurological function using the American Spinal Cord Injury Association(ASIA)scale,and evaluate the safety of the surgery.Results There were statistical differences between different vertebral puncture angles and the distance of the paravertebral process opening(F=69.850,105.23,P<0.05),and the distance of T_(8)-L_(5)vertebral puncture and paravertebral process opening gradually increased.All patients underwent surgery smoothly,with a success rate of 100.00%(30/30)for one needle puncture and 93.33%(28/30)for unilateral approach.The surgical time was 25-38(30.25±3.00)minutes,and the amount of bone cement injected was 1.69-5.23(3.85±1.22)mL.Compared with preoperative,the vertebral height at 1 and 6 months postoperatively increased(t=20.266,17.887,P<0.05),and the Cobb angle at 1 and 6 months postoperatively decreased(t=24.932,22.159,P<0.05).Compared with preoperative,the ASIA scores at 1 and 6 months after surgery were improved(t=69.763,76.681,P<0.05).All patients underwent CT or X-ray examinations on the first day after surgery,which showed good bone cement deposition.No complications occurred in all patients during the 6-month follow-up.Conclusion There are differences in the puncture angle and puncture point selection of PVP in CT image simulation puncture paths,which can improve the success rate of PVP surgery and promote patient prognosis.