单侧入路经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的术前计算机辅助设计

Preoperative Computer-aided Design of Percutaneous Kyphoplasty via Unilateral Approach for Osteoporotic Vertebral Compression Fracture Based on 3D-CT

目的 对于拟行手术单侧入路的经皮椎体后凸成形术(percutaneous kyphoplasty, PKP)的骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures, OVCF)患者,基于3D-CT进行术前计算机辅助设计(computer aided design, CAD)穿刺路径,并通过临床实践探究此种术前设计的可行性及有效性。方法 采用回顾性病例对照研究方法,纳入分析了31例患者样本,完成42例椎体手术,手术采用单侧入路PKP。通过3D-CT进行术前CAD,确定皮肤穿刺点、穿刺角度及骨性锚定点,术中在G型臂透视下严格按照术前设计进行操作,记录手术时间、透视次数、对侧补充穿刺次数、骨水泥渗漏率、并发症出现率,比较术前术后视觉模拟评分(visaul anlogue scale, VAS)、Oswestry功能障碍指数(oswestry diablity index, ODI)、椎体高度恢复情况。统计学软件采用SPSS 26.0,计量数据采用均数±标准差表示。结果 (1)手术时间为(26.21±4.19)min,中位数25 min;透视次数为(22.69±6.25)次,中位数21次;对侧补充穿刺数0次;(2)术后3 d、3个月较术前疼痛情况均得到显著改善,VAS评分降低,差值差异有统计学意义(P<0.001),术后3月较术后3 d的VAS评分差异无统计学意义(P>0.05);(3)术后3 d、3个月较术前功能障碍情况均得到显著改善,ODI评分降低,差值差异有统计学意义(P<0.001),术后3月较术后3 d的ODI评分差异无统计学意义(P>0.05);(4)术后3 d、3个月较术前椎体高度比值增加,差值差异有统计学意义(P<0.001),术后3月较术后3 d椎体高度比值降低,差值为0.60,差值存在统计学意义(P<0.001);(5)骨水泥外渗8例,渗漏率为19.0%,无椎体后方渗漏,无症状性渗漏,无其他并发症发生。结论 此种基于3D-CT进行术前CAD的单侧入路PKP方法,穿刺成功率高、操作简单易学、可形成标准化流程。骨性锚定点的引入,可纠正因皮肤延展性导致的移位误差。经临床实践证实,该方法具有可行性及有效性,且不需要使用昂贵的辅助设备,为在基层医院推广提供了可能性,具备实用的临床参考价值。

Objective For patients with osteoporotic vertebral compression fractures(OVCF)undergoing unilateral percutaneous kyphoplasty(PKP),a preoperative computer-aided design(CAD)of the puncture pathway is based on 3D-CT imaging.This study explores the feasibility and effectiveness of such preoperative designs through clinical practice.Methods A retrospective case-control study was conducted,including an analysis of 31 patient samples and completing 42 vertebral surgeries using unilateral approach PKP.Preoperative CAD was conducted through 3D-CT to determine the skin puncture point,the puncture angle,and the bony anchorage point.During surgery,the procedure was carried out strictly according to the preoperative design under G-arm fluoroscopy,recording surgery duration,the number of fluoroscopy times,contralateral supplementary puncture times,bone cement leakage rate,and the incidence of complications.The preoperative and postoperative Visual Analogue Scale(VAS),Oswestry Disability Index(ODI),and vertebral height restoration were compared.Statistical software SPSS 26.0 was used,with quantitative data expressed as mean±standard deviation,and denoted as(±s).Results(1)The operation time was(26.21±4.19)min,with a median of 25 min;the number of fluoroscopy was(22.69±6.25)times,with a median of 21 times;the number of contralateral supplementary punctures was 0;(2)the pain level was significantly improved 3 days and 3 months after surgery,the VAS score was decreased,the difference was statistically significant(P<0.001).There was no statistically significant difference between the VAS score 3 months after surgery and 3 days after surgery(P=0.11,P>0.05);(3)after 3 days and 3 months,the dysfunction was significantly improved,the ODI score was decreased,the difference was statistically significant(P<0.001).The ODI score at 3 months after surgery was not statistically significant(P>0.05);(4)the ratio of vertebral height at 3 days and 3 months after surgery was higher than that before surgery,with statistical significance(P<0.001).The ratio of vertebral height at 3 months after surgery was lower than that at 3 days after surgery,with a difference of 0.60 and the difference was statistically significant(P<0.001);(5)there were 8 cases of bone cement extravasation and the leakage rate was 19.0%with no posterior vertebra leakage,no symptomatic leakage,and no other complications.Conclusion The unilateral approach PKP method based on preoperative CAD with 3D-CT has a high success rate of puncture,simple operation,and is easy to learn,allowing the formation of a standardized procedure.The introduction of osseous anchoring points can correct the displacement errors caused by skin elasticity.Clinical practice has confirmed that this method is feasible and effective,without the need for expensive assistive equipment.This offers the possibility for popularization in primary hospitals and holds practical clinical reference value.