O臂导航在下胸椎、腰椎单侧入路经皮椎体成形术中的应用  

Application of O-arm navigation for percutaneous unilateral approach lower thoracic and lumbar vertebroplasty

作　　者：黄圣斌[1,2] 谢兆林[1] 韦灿燊 潘愈嘉 杨克勤[1] 罗翔[1] 黄文华 Huang Shengbin;Xie Zhaolin;Wei Canshen;Pan Yujia;Yang Keqin;Luo Xiang;Huang Wenhua(Department of orthopedics,Guigang people's Hospital,Guigang 537100,China;Guangxi Medical University,Nanning 530021;Southern Medical University,Guangzhou 510000,China)

机构地区：[1]广西贵港市人民医院骨科,贵港537100 [2]广西医科大学,南宁530021 [3]南方医科大学,广州510000

出　　处：《广西医科大学学报》2021年第10期1980-1984,共5页Journal of Guangxi Medical University

基　　金：广西贵港市科技成果转化与应用(No.贵科转1701004);广西贵港市骨科疾病临床研究中心(No.贵科通200810);广西数字医学与3D打印临床医学研究中心建设(No.桂科AD17129017)。

摘　　要：目的:探讨O臂导航在下胸椎、腰椎单侧入路椎体成形手术中的作用及其安全性。方法:选择2017年9月至2020年6月广西贵港市人民医院收治的因骨质疏松性椎体压缩骨折(OVCF)接受经皮椎体成形手术(PVP)的患者共160例,按随机数字表法分为导航组80例和传统组80例,导航组采用O臂联合计算机三维导航进行穿刺放置工作套管。传统组采用O臂二维模式透视下穿刺置入工作套管。两组病例均采用单侧入路,若单侧穿刺位置不佳预计骨水泥弥散不均者,同时作对侧穿刺。比较两组工作套管放置时间、平均放射剂量、骨水泥渗漏例数、需对侧手术例数及术前与术后第1天、末次随访VAS评分。结果:两组患者术后背痛症状均获得有效缓解;导航组工作通道放置时间及平均手术时间均明显短于传统组(P<0.05);导航组平均累计放射剂量明显低于传统组(P<0.05);导航组骨水泥渗漏和需对侧手术发生率均明显低于传统组(均P<0.05)。导航组与传统组术后的VSA评分较术前均有明显降低(P<0.05),但两组间差异不明显(P>0.05)。结论:利用O臂导航可以在椎体成形手术中精准实现穿刺与工作套管的置入,提高穿刺准确率,减少骨水泥渗漏率,缩短穿刺及手术时间,减少术者及患者辐射暴露剂量,临床效果满意。Objective:To investigate the safety and clinical value of O-arm navigation appalication in vertebroplasty for unilateral lower thoracic and lumbar.Methods:From September 2017 to June 2020,160 patients with osteoporotic vertebral compression fracture(OVCF)underwent percutaneous vertebroplasty(PVP)in our hospital were selected,and randomly divided into navigation group and traditional group,with 80 cases in each group.The patients in navigation group received O-arm combined with three-dimensional navigation to place the working tube.In the traditional group,the o-arm two-dimensional fluoroscopy was used to puncture and place the working tube.Unilateral approach was used in both groups.If the puncture location was not good and the bone cement dispersion was expected to be uneven,the contralateral puncture was performed at the same time.The placement time of working tube,average radiation dose,the number of cases bone cement leakage,the number of cases required contralateral operation,and the VAS scores before operation,1 day after operation and the last follow-up were compared.Results:The symptoms of postoperative back pain in both groups were effectively relieved.The working tube placement time,the average operation time,the average radiation dose,the incidence of bone cement leakage,and contralateral operation rate in navigation group were significantly lower than those in traditional group before operation(P<0.05).There was no significant difference in postop-erative VSA score between the two groups(P>0.05).Conclusion:O-arm navigation for vertebroplasty can achieve accurate the puncture and working tube placement,improve the puncture accuracy,reduce the bone cement leakage,shorten the puncture time and operation time,reduce the radiation exposure dose of patients,and the clinical effect is satisfactory.

关 键 词：O臂 计算机导航 椎体成形术 椎体压缩性骨折 

分 类 号：R687.3[医药卫生—骨科学]