红外线透视导航下经皮椎体成形术治疗椎体骨质疏松压缩性骨折28例-《中国微创外科杂志》

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Title:: Infrared fluoroscopic navigation guiding percutaneous vertebroplasty for osteoporotic vertebral compression fractures in 28 cases

作者:: 王黎明; 喻忠; 桂鉴超; 徐杰; 王钢锐; 郑圣鼐; 姚京东; 侯明夫; 南京医科大学附属南京第一医院脊柱外科中心,南京,210006

Author(s):: Wang Liming; Yu Zhong; Gui Jianchao; et al.; Spinal Surgery Center, Nanjing First Hospital of Nanjing Medical University, Nanjing 210006, China

关键词:: 透视导航; 经皮椎体成形术; 骨质疏松; 压缩性骨折?

Keywords:: Fluoroscopic navigation; 　Percutaneous vertebroplasty; 　Osteoporotic; 　Vertebral compression fracture

分类号:: R683.2?

文献标志码:: A

摘要:: 目的探讨红外线透视导航下经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性压缩性骨折的疗效. 方法红外线透视导航下PVP治疗骨质疏松性压缩性骨折28例(41个椎体),骨折部位为T6～L4,其中胸椎16个椎体,腰椎25个椎体.将参考架固定于病椎棘突,C形臂X线机拍正侧位图像,对穿刺针进行记录获得透视图像上的虚拟影像.术后复查X 线及CT检查了解骨折椎体复位情况、椎体的容量变化、骨水泥分布及外漏情况,CT容量分析法观测手术前后椎体的容积变化,观察手术前后疼痛强度评价的视觉类比评分的变化. 结果 41个椎体成功注射骨水泥.13个椎体行PVP;28个椎体行经皮后凸成形术(percutaneous kyphoplast,PKP),其中12例行球囊扩张成形,16例行sky膨胀式椎体成形.单椎体注射17例,2个椎体注射9例,3个椎体注射2例.26个椎体采用单侧椎弓根注射,15个椎体采用双侧椎弓根注射.无手术死亡,无神经根及脊髓受损情况无肺栓塞及心脑血管系统急性反应.PVP手术时间7.7～20.7 min/椎体,(14.2±3.3) min/椎体;PKP手术时间11.2～32.4 min/椎体,(21.8±5.4) min/椎体.X线照射剂量为5.4～19.6 dGy/椎体,(12.5±3.6)dGy/椎体.注射骨水泥2.2 ～6.8 ml/椎体,(4.6±1.2)ml/椎体.椎体体积由术前(21.4±4.6) cm3增至术后 (25.8±5.4) cm3(t=5.623,P＝0.000).VAS由术前 (7.6±1.2)分下降为术后48 h(2.9±0.7)分(t=12.946,P=0.000).28例平均随访8个月(3～14个月),无严重并发症,无椎体塌陷. 结论红外线透视导航PVP可行,可提高手术精确度和安全性.

Abstract:: Objective　To study curative effects of infrared fluoroscopic navigation guided percutaneous vertebroplasty for osteoporotic vertebral compression fractures.　M ethods　A total of 28 cases of osteoporotic vetebral compression fractures (41 vertebrae) underwent infrared fluoroscopic navigation guided percutaneous vertebroplasty. The fracturewas located atT6~L4segment, including 16 thoracic vertebrae and 25 lumbar vertebrae. Fluoroscopic images of the spine were obtained, calibrated, and saved after the reference shelfwas fixed on the spinous process of fractured vertebrae. The trajectory, a virtual tool corresponding to the tracked too,l was overlaid onto the saved fluoroscopic views in real time. Postoperative X-ray and CT examinationswere performed to observe the vertebral body diaplasis aswell as the distribution and leakage ofbone cement. The vertebral body volume wasmeasured with CT volumetry preoperatively and postoperatively. The visual analogue scale (VAS) scoreswere compared before and after operation.　 Results　The bone cement was successfully injected in all the 41 vertebrae. Percutaneous vertebroplasty was performed in 13 vertebrae, while percutaneous kyphoplasty was conducted in 28 vertebrae ( including balloon expansion in 12 vertebrae and“sky” expansion in 16 vertebrae). Vertebralbody injectionwas performed via unilateralpedicle in 26 vertebrae and via bilateralpedicle in 15 vertebrae. Of the 28 cases, cement injectionwas carried out in one vertebralbody in 17 cases, in two vertebralbodies in 9 cases, and in three bodies in 2 cases. No intraoperative deaths, nerve root or spinal cord injuries, or pulmonary embolism and cardiovascular or cerebrovascular emergencies occurred. The operative time for each vertebra was 7. 7~20. 7 min (14. 2±3. 3 min) in percutaneous vertebroplasty and 11. 2~32. 4 min (21. 8±5. 4 min) in percutaneous kyphoplasty. The X-ray exposure dose for each vertebra was 5·4~19·6 dGy (12. 5±3. 6 dGy). The amount of injected cement for each vertebra was 2. 2 ~6. 8 ml (4. 6±1. 2 ml). The vertebral volumewas elevated from preoperative 21. 4±4. 6 cm3 to postoperative 25. 8±5. 4 cm3 (t=5.623, P=0. 000). The VAS scores decreased from preoperative 7. 6±1. 2 to postoperative 2. 9±0. 7 (t=12.946, P=0. 000). No serious complications or vertebral collapseswere found during follow-up examinations for3~14 months (mean, 8 months) in the 28 cases.　Conclusions　 Use of infrared fluoroscopic navigation for guiding percutaneous vertebroplasty is feasible.

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

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