结合术前CT规划及术中透视建立穿刺通道技术在老年骨质疏松性椎体压缩性骨折手术中的应用  

Establishment of bone access based on preoperative measurements of CT imaging and intraoperative fluoroscopic guidance for the surgical treatment of osteoporotic vertebral compression fracture

作　　者：吴静晔[1] 韦祎[1] 李加宁[1] 张宁[1] 李楠[1] 刘波[1] 何达[1] 刘亚军[1] 王玉梅[1] 田伟[1] WU Jing-ye;WEI Yi;LI Jia-ning;ZHANG Ning;LI Nan;LIU Bo;HE Da;LIU Ya-jun;WANG Yu-mei;TIAN Wei(Department of Spine Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院脊柱外科

出　　处：《实用老年医学》2019年第8期801-805,共5页Practical Geriatrics

基　　金：北京市医院管理局"青苗"计划(QML20180402)

摘　　要：目的评估利用术前CT进行术前设计,再结合术中透视引导的穿刺通道技术在老年骨质疏松性椎体压缩性骨折(OVCF)手术中的有效性和安全性。方法2017年7月至2018年6月连续选择年龄>60岁的OVCF病人,对符合纳入标准的病人行椎体成形术(PVP)或椎体后凸成形术(PKP),术前在伤椎的轴位CT图像上确定经皮入针的横向距离和角度,并通过测量确定骨面入点和椎弓根内壁的位置关系;术中透视确定经皮入针的纵向距离和角度,穿刺至骨面时,结合术前CT的测量结果在正位片上确定骨面入点的位置。以该技术的穿刺成功率作为主要评价指标,并比较病人术前和术后视觉疼痛评分(VAS)及术中并发症。结果研究共纳入43例病人,男10例,女33例,平均年龄(73.4±10.1)岁。共对50个节段进行PVP或PKP操作,节段范围为T5~L5,其中T12~L5节段所占比例为86%。穿刺成功率为96%(48/50),2个节段穿刺骨钻尖端没能到达对侧椎体,分别发生在L5和T5水平,骨水泥的弥散偏向一侧。术后仅有2例为通过椎体静脉窦渗漏至椎管,病人术后没有出现神经功能障碍。术前和术后VAS评分比较,差异有统计学意义(P<0.01)。结论利用术前CT进行术前设计,再结合术中透视引导建立穿刺通道的技术在OVCF手术治疗中是安全和有效的。Objective To evaluate the accuracy and safety of the technique establishing bone access based on the preoperative planning on CT images and intraoperative fluoroscopic guidance during the procedure for surgical treatment of osteoporotic vertebral compression fracture(OVCF).Methods This prospective study recruited consecutive patients older than 60 years who suffered from OVCF from July 2017 to June 2018.The patients underwent treatment of vertebroplasty or kyphoplasty.During the procedure,establishing technique of bone access involved preoperative trajectory planning based on CT images and intraoperative fluoroscopic guidance.Firstly,the transverse distance at skin and transverse angulation of the percutaneous trajectory were measured on CT axial images of the index vertebra.The relationship between the entry point at bony surface and inner pedicle cortex was confirmed as well.Secondly,the longitudinal distance at skin and longitudinal angulation of the trajectory were determined on intraoperative fluoroscopy.Once the needle touched the bony surface,the entry site was confirmed based on preoperative measurements on CT.The primary outcome measurement was the success rate of this technique.Visual Analogue Scale(VAS)were assessed compared before and after operation.Results A total of 43 patients including 10 males and 33 females with an average age of 73.4±10.1(ranging from 50 to 92)years were included.Fifty segments underwent PVP or PKP procedure,ranging from T5 to L5(86%of them were T12-L5).The success rate of this technique was 96%(48/50),while the bone access which did not reach the contralateral side of vertebral body was L5 and T5.Only 2 cases of cement leakage into the spinal canal occurred through the perivertebral venous plexus.And no neurological symptoms and signs occurred.VAS before operation showed significant difference with that after operation(P<0.01).Conclusions The establishing technique of bone access based on preoperative measurements on CT imaging and intraoperative fluoroscopic guidance during

关 键 词：椎体压缩性骨折 骨质疏松 椎体后凸成形术 椎体成形术 穿刺通道 老年人 

分 类 号：R68[医药卫生—骨科学]