CT影像数据指导单侧经皮椎体后凸成形术治疗中上胸椎压缩骨折  

CT imaging data guide unilateral percutaneous kyphoplasty for the treatment of middle upper thoracic compression fractures

作　　者：孙育良 熊小明[1] 万趸[1] 邓轩赓[1] 石华刚[1] 周杰[1] 宋偲茂[1] 顾韬 侯伟[1] SUN Yu-liang;XIONG Xiao-ming;WAN Dun;DENG Xuan-geng;SHI Hua-gang;ZHOU Jie;SONG Si-mao;GU Tao;HOU Wei(Department of Spinal Surgery,Orthopedics Hospital of Sichuan Province,Chengdu,Sichuan 610041,China)

机构地区：[1]四川省骨科医院脊柱外科,四川成都610041

出　　处：《颈腰痛杂志》2022年第6期806-809,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：四川省科技厅支撑项目(编号:2015SZ0190)。

摘　　要：目的 探讨参照术前三维CT影像测量数据,指导单侧椎弓根旁入路PKP手术治疗中上胸椎骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture, OVCF)的临床疗效和安全性。方法 回顾性研究2016年1月~2018年12月收治的90例(105椎)中上胸椎OVCF患者,根据治疗方式分为A、B两组:A组45例(55椎),术前在三维CT影像上测量模拟单侧经椎弓根旁入路的相关数据,参照其测量数据行PKP治疗;B组45例(50椎),采用经单侧椎弓根入路行PKP治疗。对比两组的手术情况和术后疗效、并发症情况。结果 A组的手术时间、穿刺时间、射线暴露时间均显著少于B组(P<0.05);两组的骨水泥注入量、骨水泥渗漏率无明显差异(P>0.05)。A组的骨水泥弥散面积明显高于B组(P<0.05);两组均未发生穿刺并发症。两组术后VAS评分明显低于术前(P<0.05),术后伤椎前缘高度明显高于术前(P<0.05)、后凸Cobb角明显小于术前(P<0.05)。两组比较,术后1 d~12月的VAS评分、伤椎前缘高度和椎体后凸Cobb角无明显差异(P>0.05)。术后A、B组各有5例非手术椎体再骨折,差异无统计学意义(P>0.05)。结论 经CT影像测量数据指导下的单侧椎弓根旁入路PKP手术治疗中上胸椎OVCF,具有手术时间短、穿刺准确性高、射线暴露时间少、骨水泥弥散均匀等优点,相对安全,值得应用。Objective To explore the clinical efficacy and safety of unilateral pedicle lateral approach percutaneous kyphoplasty(PKP) under the guidance of the preoperative 3 D CT image data in the treatment of middle upper thoracic osteoporotic vertebral compression fracture(OVCF). Methods A retrospective study was conducted in 90 patients(105 vertebral bodies) with middle and upper thoracic OVCF from January 2016 to December 2018. The patients were divided into two groups according to the treatment. In group A, 45 patients(55 vertebrae) received preoperative 3 D CT to simulate unilateral transpedicular approach, and PKP treatment was performed according to the measured data. In group B, 45 cases(50 vertebrae) underwent PKP treatment via unilateral pedicle approach. The operation, postoperative efficacy and complications of the two groups were compared. Results The operation time, puncture time and radiation exposure time in group A were significantly shorter than those in group B(P<0.05). There were no significant differences in the amount of bone cement injected and the leakage rate of bone cement between the two groups(P>0.05). The dispersion area of bone cement in group A was significantly higher than that in group B(P<0.05). No puncture complications occurred in both two groups. The VAS score after operation in two groups was significantly lower than before operation(P<0.05). The height of the anterior edge of injured vertebra after operation was significantly higher than before operation(P<0.05), and the kyphotic Cobb angle was significantly lower than before operation(P<0.05). There were no significant differences between the two groups in VAS score, anterior height of injured vertebra and Cobb angle of kyphosis from 1 day to 12 months after operation(P>0.05). There were 5 cases of non-operative vertebral body refracture in group A and group B after operation, and the difference was not statistically significant(P>0.05). Conclusion s Unilateral pedicle lateral approach PKP under the guidance of CT image data in the

关 键 词：CT影像 经皮椎体后凸成形术 骨质疏松 中上胸椎 椎体压缩骨折 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]