经皮椎体成形术Mimics软件骨水泥弥散率评估的意义

Significance of Mimics software calculated bone cement distribution rate for evaluation of percutaneous vertebroplasty

[目的]利用Mimics软件计算经皮椎体成形术(percutaneous vertebroplasty,PVP)后骨水泥弥散率,探讨其对经皮椎体成形术的意义。[方法]回顾性分析2021年3月—2022年12月在本院行PVP治疗患者的临床资料,依据骨水泥弥散率随机选取高弥散率组(弥散率≥20%)、中弥散率组(10%<弥散率<20%)、低弥散率组(弥散率≤10%)各40例患者,比较三组围手术期、随访及影像资料,计算弥散率与末次随访临床和影像资料的相关性。[结果]高弥散率组的骨水泥注入量显著大于中弥散率组和低弥散率组[(7.5±1.1)ml vs(6.6±1.3)ml vs(6.4±1.2)ml,P<0.001],高弥散率组骨水泥弥散率显著大于中弥散率和低弥散率组[(22.4±1.5)%vs(14.8±2.4)%vs(8.2±1.0)%,P<0.001]。高弥散率组二次骨折率显著低于中弥散率组和低弥散组[例(%),2(5.0)vs5(12.5)vs 10(25.0),P<0.001]。三组患者术后VAS及ODI评分均显著减少(P<0.05),高弥散率组术后1年VAS评分显著小于中弥散率组和低弥散率组[(1.7±0.7)vs(2.2±0.8)vs(2.3±0.5),P<0.001]。影像方面,三组患者术后椎体前缘高度、椎体前缘高度比、局部后凸角均显著改善(P<0.05)。术后1年时,高弥散率组及中弥散率组椎体前缘高度显著大于低弥散率组[(23.1±2.1)mm vs(22.2±3.1)mm vs(21.6±1.5)mm,P<0.001],高弥散率组及中弥散率组椎体前缘高度比均显著大于低弥散率组[(82.6±7.9)%vs(80.7±4.9)%vs(77.0±5.0)%,P<0.001]。两两相关分析表明,弥散率与VAS评分呈显著负相关(r=-0.333,P<0.001),与椎体前缘高度比(r=0.345,P<0.001)和椎体前缘高度(r=0.285,P=0.002)呈显著正相关。[结论]本研究中Mimics软件计算的弥散率越高,患者的临床与影像结果就越优,术后二次骨折率越低。

[Objective]To evaluate the significance of Mimics software calculated bone cement distribution rate(DR)for evaluation of percutaneous vertebroplasty(PVP).[Methods]A retrospective study was conducted on the patients who received PVP in our hospital from March 2021 to December 2022.According to the bone cement DR measured on the Mimics software,40 patients with high distribution rate(HDR)(DR≥20%),40 with medium diffusion rate(MDR)(10%<DR<20%)and 40 with low distribution rate(LDR)(DR≤10%)were selected and enrolled into this study.Perioperative,follow-up and imaging data of the three groups were compared,and the paired correlation between DR and clinical and imaging data at the last follow-up was analyzed.[Results]The HDR cohort proved significantly greater than the MDR and LDR cohorts in terms of bone cement injection volume[(7.5±1.1)ml vs(6.6±1.3)ml vs(6.4±1.2)ml,P<0.001],and the bone cement diffusion[(22.4±1.5)%vs(14.8±2.4)%vs(8.2±1.0)%,P<0.001].However,the HDR cohort was significantly less than the MDR and LDR cohorts in the secondary fracture occurrence[case(%),2(5.0)vs 5(12.5)us 10(25.0),P<0.001].The VAS and ODI scores significantly decreased with time in all three groups(P<0.05),and the VAS score in the HDR group was significantly lower than those in the MDR group and LDR group at 1 year after surgery[(1.7±0.7)vs(2.2±0.8)vs(2.3±0.5),P<0.001].As for imaging,the vertebral anterior margin height,vertebral anterior margin height ratio,and local kyphotic angle significantly improved in all three groups postoperatively compared with those preoperatively(P<0.05).At 1 year afer surgery,the vertebral anterior margin height in HDR and MDR groups was significantly higher than that in LDR group[(23.1±2.1)mm vs(22.2±3.1)mm vs(21.6±1.5)mm,P<0.001],while the vertebral anterior margin height ratio in the HDR and MDR groups was significantly higher than that in the LDR group[(82.6±7.9)%vs(80.7±4.9)%vs(77.0±5.0)%,P<0.001].As results of paired correlation analysis,the DR was a significant negative correlated with VAS score(r=-0.333,P<0.001),while positively correlated with the height of the anterior vertebral margin(r=0.345,P<0.001)and vertebral anterior margin height(r=0.285,P=0.002).[Conclusion]In this study,the higher the distribution rate calculated by Mimics software,the better the clinical and imaging results of patients,and the lower the postoperative secondary fracture rate.