术前数字化设计辅助的改良椎体成形术治疗骨质疏松性椎体压缩骨折  

Modified percutaneous vertebroplasty assisted by preoperative CT-based digital design： a new technique for osteoporotic vertebral compression fracture

作　　者：费琦[1] 赵凡[2] 孟海[1] 苏楠[1] 王炳强[1] 李东[1] 李锦军[1] 杨雍[1] 

机构地区：[1]首都医科大学附属北京友谊医院骨科,100050 [2]首都医科大学附属北京朝阳医院骨科

出　　处：《中华医学杂志》2016年第9期731-735,共5页National Medical Journal of China

摘　　要：目的探讨术前CT数据的数字化设计辅助的改良椎体成形术（PVP）治疗骨质疏松性椎体压缩骨折（OVCF）的可行性。方法2015年5至10月，首都医科大学附属北京友谊医院骨科在Mimics软件中导入单节段OVCF患者的术前连续薄层CT扫描的Dicom格式图像，制作三维有限元模型，模拟经伤椎双侧椎弓根穿刺路径，结合体表显影定位标记确定病椎PVP手术的穿刺点、穿刺方向，记录PVP现实手术的手术时间、放射透视次数、骨水泥充盈情况、手术并发症和手术前后的视觉模拟（VAS）评分，评价手术效果。结果7例OVCF患者平均年龄78（61-87）岁，PVP现实手术实施效果与术前数字化设计高度相似，手术时间（16．6±2．1）min；术中放射透视暴露次数（7．9±1．7）次，手术椎体内骨水泥充盈好，无渗漏等手术并发症；患者术前VAS评分（8．6±0．5）分，术后（1．4±0．5）分（P=0．000）。结论术前数字化设计辅助PVP可减少手术时间和术中x线透视次数，增加穿刺的准确性和减少相关并发症，临床结果满意。Objective To report a new technique of modified percutaneous vertebroplasty （PVP） assisted by preoperative CT-based digital design for osteoporotic vertebral compression fracture （ OVCF）, and to discuss its preliminary clinical results. Methods Thoracolumbar spine segment data （ Dicom format） were obtained from lamellar CT scanning of seven old female or male with single OVCF. A three-dimensional model of thoracolumbar spine and simulative PVP models （via double transpedicular approach） were built in the Mimics software. With the help of a preoperative transparent marker located at the back midline skin and preoperative digital design by Mimics software, the needle insert point and needle direction in every patient were established. The surgical time, the number of intraoperative radiation perspective, bone cement filling condition in fracture vertebra, intraoperative complications and visual analogue scale （VAS） scores before and after surgery were recorded to evaluate the preliminary clinical resuhs after modified PVP. Results The puncture process during PVP was in high accordance with the preoperative digital design by Mimics software in seven cases of single OVCF with the average age of 78 years old. The operation time was only 16. 57 ±2.07 minutes and the intraoperative radiation perspective numbers were less than ten （7. 86 ± 1.68） times. The bone cement filling in all fracture vertebras were good and no surgical complications such as spine cord injury and cement leakage were founded. The VAS scores before and after surgery were 8.57 ± 0.53 points and 1.43± 0. 53 point （ P = 0. 000 ）, respectively. Conclusion Percutaneous vertebroplasty （PVP） assisted by preoperative CT-based digital design has high accuracy, which is expected to reduce operation time, intraoperative radiation exposure and the surgical complications related to puncture failure.

关 键 词：脊柱疾病 模拟数字转换 骨质疏松 骨折应力性 经皮椎体成形术 

分 类 号：R687.3[医药卫生—骨科学]