三维可视化技术在经皮椎体成形术术后椎体感染病灶清除中的应用

Application of digital visualization in surgical clearance of vertebral infection lesions following percutaneous vertebroplasty

目的探讨三维可视化技术在经皮椎体成形术(PVP)术后椎体感染病灶清除术前规划中的应用效果。方法回顾性分析2016年1月至2022年12月郑州市骨科医院脊柱外科收治的13例PVP术后椎体感染行一期后路病灶清除植骨融合内固定术的患者资料。男4例,女9例;年龄(71.4±6.5)岁。术前将患者的CT原始数据导入Mimics软件,重建出脊柱的三维模型,通过在模型上观察骨水泥的分布以及其与椎板、椎弓根、关节突、脊髓的位置关系,设计椎管内手术的安全区域,术中操作按照术前规划进行。记录患者的手术时间、术中出血量、美国脊髓损伤协会(ASIA)分级的改善情况、术后并发症等。比较患者术前、术后2周、术后3个月和末次随访时的红细胞沉降率(ESR)、C-反应蛋白(CRP)、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评定疗效。结果13例患者均按术前规划顺利完成手术,手术时间为(275.9±28.3)min,术中出血量为(865.4±183.0)mL。所有患者术后随访(24.7±9.4)个月。术后2周、3个月及末次随访时的ESR、CRP、疼痛VAS评分、ODI均较术前显著降低,差异均有统计学意义(P<0.05)。末次随访时X线及CT检查显示内固定位置良好、植骨融合充分。5例患者的ASIA分级由术前的D级恢复至E级。无切口感染、窦道形成、神经症状加重等,未发现内固定物松动、断裂、神经功能障碍加重等。结论三维可视化技术辅助下可直视脊髓、骨水泥、清创区域,减少神经损伤并发症的发生,为PVP术后椎体感染病灶清除提供一种安全、有效的术前规划方法。

ObjectiveTo evaluate the application of digital visualization in preoperative planning for surgical clearance of vertebral infection lesions following percutaneous vertebroplasty(PVP).MethodsA retrospective study was conducted to analyze the 13 patients with infectious spondylitis following PVP who had undergone one-stage posterior debridement and interbody bone grafting combined with instrumentation at Department of Spinal Surgery,Zhengzhou Orthopaedics Hospital from January 2016 to December 2022.They were 4 males and 9 females with an age of(71.4±6.5)years.Before surgery,the CT raw data of the patients were imported into software Mimics to reconstruct a three-dimensional model of the spine.After the distribution of bone cement in the model and its relationships with the vertebral plate,pedicle,articular process,and spinal cord were observed,a safe area for spinal canal surgery was designed.Intraoperative operations were carried out according to the preoperative planning.Surgical time,intraoperative blood loss,improvements in American Spinal Injury Association(ASIA)grading,and postoperative complications were recorded.The therapeutic efficacy was evaluated by comparisons of erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),visual analogue scale(VAS),and Oswestry disability index(ODI)between preoperation,2 weeks and 3 months postoperation,and the last follow-up.ResultsSurgery went on successfully in all the 13 patients according to the preoperative planning.The surgical time was(275.9±28.3)min and the intraoperative blood loss(865.4±183.0)mL.All patients were followed up for(24.7±9.4)months.The levels of ESR,CRP,VAS,and ODI at 2 weeks,3 months and the last follow-up were significantly lower than those before surgery(P<0.05).At the last follow-up,X-ray and CT examinations showed good positions of internal fixation and sufficient bone graft fusion.The ASIA grading recovered from preoperative D to E in 5 patients.No incision infection,sinus formation,worsening of neurological symptoms,loosening or rupture of internal fixation,or worsening of neurological dysfunction were found.ConclusionWith the assistance of 3D visualization,the spinal cord,bone cement,and debridement area can be visualized directly to reduce nerve injury complications so that a safe and effective preoperative planning can be made for surgical clearance of vertebral infection lesions following PVP.