基于CT三维重建分析探讨经皮椎体成形术后伤椎骨密度变化

Vertebral bone density changes after percutaneous vertebroplasty based on CT 3D reconstruction

目的采用Mimics三维重建技术分析骨质疏松性椎体压缩骨折患者经皮椎体成形术后伤椎的骨密度变化情况。方法回顾性选取2015年10月~2022年10月南方医科大学珠江医院收治的因骨质疏松性椎体压缩骨折行经皮椎体成形术并于术后返院复查的患者45例,根据返院复查时间分为A组(1~3月,n=16)、B组(4~12月,n=14)、C组(>12月,n=15)。将患者CT数据导入Mimics软件行伤椎和上下邻椎节段椎骨三维重建,分离椎弓根、肋骨、皮质骨和骨水泥得到所需椎体松质骨模型并使用软件读取平均CT值代表其骨密度(BMD),术前与术后分别记为BMD1和BMD2,计算BMD变化率。结果A组中伤椎BMD高于术前(P<0.05),上下邻椎无明显差异;B组中伤椎BMD高于术前(P<0.05),上下邻椎BMD低于术前(P<0.05);C组中伤椎BMD无明显变化,上下邻椎BMD低于术前(P<0.05)。伤椎BMD变化率在A、B组的差异无统计学意义(P>0.05),但均明显高于C组(P<0.05);上下邻椎BMD变化率B、C组的差异无统计学意义(P>0.05),但均低于A组(P<0.05)。结论经皮椎体成形术后短期内伤椎骨密度增加,邻椎无明显变化,随着术后时间增加各椎体均出现骨密度降低情况。

Objective To analyze the changes in bone mineral density(BMD)of vertebral bodies after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures using Mimics 3D reconstruction.Methods We conducted a retrospective analysis of 45 patients treated from October 2015 to October 2022 at Zhujiang Hospital of Southern Medical University.Patients were categorized into three groups based on the follow-up period post-surgery:group A(1-3 months,n=16),group B(4-12 months,n=14),group C(over 12 months,n=15).CT data were used for 3D reconstruction of vertebral models in Mimics software,which involved differentiating pedicles,ribs,cortical bone,and bone cement to isolate the cancellous bone of vertebrae.Mean CT values were used to represent BMD before and after surgery(BMD1 and BMD2),and the rate of BMD change was calculated.Results In group A,BMD of the treated vertebra was significantly higher postsurgery(P<0.05),with no significant changes in adjacent vertebrae.In group B,BMD of the treated vertebra increased postsurgery(P<0.05),with a decrease in BMD of adjacent vertebrae(P<0.05).In group C,there was no significant change in BMD of the treated vertebra,and a decrease in BMD of adjacent vertebrae(P<0.05).The rate of BMD change in the treated vertebrae between groups A and B was not statistically significant(P>0.05),but both were significantly higher than in group C(P<0.05);the rate of BMD change in adjacent vertebrae in groups B and C was also not significantly different(P>0.05),but both were lower than in group A(P<0.05).Conclusion BMD of the treated vertebra increased in the short term after percutaneous vertebroplasty,with no significant changes in adjacent vertebrae.Over time,BMD decreased in all evaluated vertebrae.