基于术前CT测量精准定位穿刺与传统穿刺经皮椎体成形术治疗胸腰椎压缩性骨折的对照研究

Comparative Study of Precise CT-Guided Percutaneous Vertebroplasty versus Traditional Percutaneous Vertebroplasty for Thoracolumbar Compression Fractures

目的:通过和传统经皮穿刺方法的回顾性研究,探讨基于术前CT测量精准定位穿刺点的经皮穿刺技术辅助的经皮球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(Osteoporotic vertebral compressive fractures,OVCFs)患者的临床疗效。方法:回顾性分析2017年1月至2021年6月采取经皮穿刺球囊扩张椎体后凸成形术治疗的56例骨质疏松性椎体压缩性骨折患者,均为单节段骨折,受伤至手术时间小于一个月。根据术中定位穿刺点方法的不同分为两组:A组:基于术前CT测量精准定位穿刺组,B组:传统方法定位穿刺组。每组各28例,对比两组患者术中穿刺次数、透视次数及手术时间,采用手术前后的视觉模拟评分(Visual analogue scale,VAS)评估临床疗效;同时观察手术相关并发症发生情况。结果:56例患者均获成功穿刺,术后随访8~16个月,平均随访时间10个月。基于术前CT测量方法精准定位穿刺组手术时间(34.1±7.5)min,术中穿刺过程中C臂机透视(9.9±2.5)次,每节病椎骨水泥注入量(5.7±0.8)mL。术前VAS评分(8.2±0.8),术后6月为(1.4±0.6)。传统方法定位穿刺组手术时间(48.8.±9.5)min,术中穿刺过程中C臂机透视(14.5±3.5)次,每节病椎骨水泥注入量(5.6±0.6)mL。术前VAS评分(8.2±0.7),术后6月为(1.5±0.6)。两组骨水泥注入量和及术后6月的VAS评分差异无统计学意义(P>0.05);术中穿刺次数、手术时间和术中透视次数差异有统计学意义(P<0.05)。其中基于术前CT测量定位穿刺组一次性穿刺成功率为92.9%(26/28)。远高于传统穿刺组53.6%(15/28)。A组发生2例向椎体后缘或侧方骨水泥渗漏;B组3例发生椎体后缘及椎体前方和侧方渗漏。两组术中均未出现神经脊髓损害并发症发生,无感染等伤口并发症发生。结论:相较于传统经皮穿刺方法,基于术前PACS系统CT精准测量定位穿刺点的技术,可大大提高一次性穿刺成功概率,明显改善经皮穿刺技术的精准性;从而可以减少手术穿刺过程中的C臂机透视次数及手术时间,具有更加精准、微创的特点,是一种精准有效和安全可靠的穿刺定位技术。

Objective:To retrospectively compare the clinical efficacy of percutaneous kyphoplasty(PKP)assisted by precise CT-guided puncture with traditional percutaneous methods in patients with osteoporotic vertebral compression fractures(OVCFs).Methods:A retrospective analysis was conducted on 56 patients who underwent PKP for single-segment OVCFs between January 2017 and June 2021.Patients were divided into two groups based on different methods of intraoperative puncture site localization:Group A(precise CT-guided puncture)and Group B(traditional method).Each group consisted of 28 patients.The number of puncture attempts,fluoroscopy times,and operation duration were compared between the two groups.Clinical efficacy was assessed using Visual Analogue Scale(VAS)scores preoperatively and postoperatively.Incidence of procedure-related complications was also monitored.Results:All 56 patients underwent successful puncture and were followed up for an average of 10 months(range:8~16 months).In Group A(precise CT-guided),the mean operation time was 34.1±7.5 minutes,fluoroscopy times during surgery wer 9.9±2.5,and cement injection volume per fractured vertebra was 5.7±0.8mL.Preoperative VAS score was 8.2±0.8,which decreased to 1.4±0.6 at 6 months postoperatively.In Group B(traditional method),the mean operation time was 48.8±9.5 minutes,fluoroscopy times were 14.5±3.5,and cement injection volume per fractured vertebra was 5.6±0.6mL.Preoperative VAS score was 8.2±0.7,which decreased to 1.5±0.6 at 6 months postoperatively.There were no statistically significant differences between the two groups in terms of cement injection volume and VAS scores at 6 months postoperatively(P>0.05).However,significant differences were found in the number of puncture attempts,operation time,and fluoroscopy times during surgery(P<0.05).Group A achieved a significantly higher single-puncture success rate of 92.9%(26/28)compared to 53.6%(15/28)in Group B.Complications included cement leakage towards the posterior or lateral aspects of the vertebra in 2 cases in Group A and in 3 cases involving both anterior and lateral aspects in Group B.No neurological or spinal cord injury complications occurred in either group,and there were no wound infections.Conclusion:Precise CT-guided puncture based on preoperative PACS system CT measurements significantly improves the success rate of single-puncture procedures and enhances the accuracy of percutaneous techniques compared to traditional methods.This approach reduces the number of fluoroscopy sessions and operation time,offering a more precise,minimally invasive alternative for treating OVCFs.It is deemed a safe,reliable,and effective technique.