Innova 3D技术指导经皮椎体成形穿刺路径:降低骨水泥渗透发生率  

Innova 3D-guided percutaneous vertebraplasty puncture reduces bone cement breakage

作　　者：李松华[1] 杨凯[1] 申玉兰[1] 田庆华[1] 吴春根[1] 

机构地区：[1]上海市第六人民医院介入放射科,上海市201306

出　　处：《中国组织工程研究》2015年第16期2473-2478,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:经皮椎体成形为修复脊柱压缩性骨折及肿瘤脊柱转移一种新的手段,在该修复方法中采用数字减影血管造影-Innova 3D技术对穿刺路径进行引导,可有效防止骨水泥外渗等情况出现。目的:探讨数字减影血管造影-Innova 3D技术对经皮椎体成形穿刺路径的影响。方法:2014年3至9月纳入72例患者共94个脊柱椎体行经皮椎体成形治疗,随机分为两组,对照组36例46个椎体不应用Innova 3D技术,实验组36例48个椎体应用Innova 3D技术,所有病灶术后均应用螺旋CT检查对骨水泥分布情况进行评估。两组间图像质量比较采用非参数的Kruskal-Wallis检验。结果与结论:对照组29例骨水泥无或轻微渗漏,7例渗漏较明显:其中2个椎体为椎间盘渗漏,2个椎体为椎旁软组织渗漏,2个椎体为静脉丛渗漏,1例为椎弓根渗漏;实验组35例骨水泥无或轻微渗漏,1例渗漏较明显。实验组采用Innova 3D技术,骨水泥渗漏及透视时间较对照组有明显优势,差异有显著性意义(P<0.05)。提示数字减影血管造影-Innova 3D技术可在经皮椎体成形术中实时建立多平面图像,及时指导调整穿刺路径,从而降低骨水泥渗漏等并发症的发生。BACKGROUND： Percutaneous vertebraplasty is a new means for the treatment of vertebral compression fractures and bone metastases. The multiplaner reconstruction with digital substraction angiography （DSA）-Innova 3D plays an important role in guiding the percutaneous vertebraplasty puncture, which can effectively prevent the leakage of bone cement. OBJECTIVE： To explore the value of DSA-lnnova 3D in the guidance of puncture of percutaneous vertebroplasty. METHODS： From March 2014 to September 2014, a total of 72 patients with 94 vertebras were selected for percutaneous vertebraplasty, of whom 36 （48 vertebras） with Innova 3D （experimentalgroup） and 36 （46 vertebras） without Innova 3D （control group）. Spiral CT scan was performed in all patients to assess the distribution of bone cement. The imaging quality in the two groups was compared by Mann-Whitney U test. RESULTS AND CONCLUSION： CT showed bone cement leakage occurred in 7 of the 36 patients in the control group. Leakages were into the lumber disc in two cases, paravertebral space in two cases, vertebral pedicle in one case or veins in two cases. However, only one case of bone cement leakage was observed in the experimental group. With the guidance of DSA-Innova 3D, the experimental group had signficantly lower leakage and fluoroscopic time than the control group （P 〈 0.05）. The multiplaner reconstruction with DSA-Innova 3D plays an important role in guiding the percutaneous vertebraplasty puncture, thereby effectively reducing the leakage of bone cement.

关 键 词：椎体成形术 血管造影术 数字减影 图像处理 计算机辅助 生物材料 骨生物材料 经皮椎体成形 Innova 3D技术 穿刺 数字减影血管造影 图像处理 透视时间 骨水泥渗透 并发症 

分 类 号：R318[医药卫生—生物医学工程]