CT多曲面重建在C臂引导经皮骶骨成形术中的应用  

The application of CT multi-planar reconstruction in C-arm fluoroscopy-guided percutaneous sacroplasty

作　　者：孙飞虎 何仕诚[2] 王卫东 朱海东[2] 方文[2] 杜瑞杰[2] 范晨 SUN Feihu;HE Shicheng;WANG Weidong;ZHU Haidong;FANG Wen;DU Ruijie;FAN Chen(Department of Interventional Radiology,Affiliated Wuxi Municipal People's Hospital,Nanjing Medical University,Wuxi,Jiangsu Province 214000,China)

机构地区：[1]南京医科大学附属无锡人民医院介入科,江苏无锡214000 [2]东南大学附属中大医院介入与血管外科

出　　处：《介入放射学杂志》2021年第8期788-791,共4页Journal of Interventional Radiology

摘　　要：目的探讨术前行多排螺旋CT扫描及多曲面重建(MPR)技术建立模拟穿刺路径对C臂下行经皮骶椎成形术(PSP)术中实际入路的指导价值。方法收集2014年至2017年东南大学附属中大医院收治17例患者资料,17例患者术前均经过多排螺旋CT扫描并行MPR建立模拟穿刺入路,分别测量棘突旁开距离(AC)、椎弓根横向角(AOC)及腰骶角(AOB),并与术中实际测量值行配对t检验。所有病例均在C臂透视引导下经椎弓根入路进行操作,术后3 d内CT复查观察骨水泥分布及有无渗漏,术后7 d内观察并发症情况。结果 17例20节次椎体成形均获成功,所有椎体术前均建立模拟穿刺路径,术前模拟AC、AOC分别为(4.3±0.4) cm、30.5°±1.9°,与术中实际测量值(4.5±0.5) cm、30.7°±1.9°,差异无统计学意义。术前腰骶角AOC为37.1°±4.1°,与术中实际测量值29.7°±3.0°,差异有统计学意义。术后CT证实椎间盘渗漏2例,骶孔渗漏1例,无穿刺路径损伤或骨水泥渗漏引起的有临床症状的并发症。结论多曲面重建可模拟骶1椎体经椎弓根入路穿刺路径,与实际针道具有较好的一致性,并可指导C臂透视下行骶骨成形术,提高实际穿刺的准确性和安全性。Objective To discuss the value of preoperative establishment of simulated puncture path based on multi-row spiral CT scanning and multi-planar reconstruction(MPR) technique in guiding C-arm fluoroscopy-guided percutaneous sacroplasty(PSP). Methods The clinical data of 17 patients, who received PSP from 2014 to 2017, were collected. Preoperative multi-row spiral CT scanning as well as MPR was performed to establish a simulated puncture path in all 17 patients. The distance away from spinous process(AC), the pedicle transverse angle(AOC) and the lumbosacral angle(AOB) were separately measured. A pairwise t-test between the obtained values and the actually measured values during the operation was conducted. Under C-arm fluoroscopy guidance, PSP via interpedicular approach was carried out in all patients. CT reexamination was performed within 3 days after PSP to observe the distribution of bone cement and to check if there was any cement leakage. The complications occurred within 7 days after PSP were recorded. Results Successful PSP was accomplished for 20 vertebral bodies in 17 patients. Preoperative establishment of simulated puncture path was performed for all 20 vertebral bodies. The preoperative simulated AC and AOC were(4.3±0.4) cm and(30.5±1.9)° respectively, during operation the actually measured values of AC and AOC were(4.5±0.5) cm and(30.7 ±1.9)° respectively, the differences between the two were not statistically significant. The preoperative AOB was(37.1±4.1)°, while the actually measured AOB was(29.7±3.0)°, the difference between the two was statistically significant. Postoperative CT scan showed that intervertebral disc cement leakage occurred in 2 patients and sacral foramen cement leakage occurred in one patient. No puncturing path injury or cement leakage-related clinical symptoms occurred. Conclusion By using MPR technique the transpedicular puncturing route to the first sacral body can be simulated on CT images, which is quite consistent with the actual needle-puncturing track. Therefor

关 键 词：骶骨成形术 腰骶角 C臂 多曲面重建 

分 类 号：R739[医药卫生—肿瘤]