经皮穿刺椎体成形术中椎体内骨质致密带的分布及影响  

Distribution and Influence of the Osteodense Zone in Vertebral Body during Percutaneous Vertebroplasty

作　　者：贾宝欣[1] 付海花 鞠静[3] 王亭[4] 沈峰[4] 刘成洲 高晓强[1] 曾祥旭 JIA Baoxin;FU Haihua;JU Jing;WANG Ting;SHEN Feng;LIU Chengzhou;GAO Xiaoqiang;ZENG Xiangxu(Linqu County People's Hospital,Linqu 262600,Shandong China;Linqu County Patriotic Health Service Center,Linqu 262600,Shandong China;Weifang People's Hospital,Weifang 261044,Shandong China;Affiliated Hospital of Qingdao University,Qingdao 266000,Shandong China)

机构地区：[1]临朐县人民医院,山东临朐262600 [2]临朐县爱卫服务中心 [3]潍坊市人民医院 [4]青岛大学附属医院脊柱外科

出　　处：《中国中医骨伤科杂志》2023年第9期36-44,共9页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：潍坊市卫健委科研项目(wfwsjk-2021-096)。

摘　　要：目的:探讨椎体内骨质致密带在新鲜骨质疏松性椎体压缩性骨折(Osteoporotic Vertebral Compression Fracture,OVCF)椎体内的分布及对骨水泥在椎体内矢状面分布的影响。方法:对2021年1月至12月确诊为新鲜骨质疏松性椎体压缩性骨折的140例患者179个椎体的术前平片、CT及MRI、术中C臂机影像资料及术后拍片复查资料进行回顾性分析,统计骨质致密带在骨折椎体内的发生率,并根据是否存在骨质致密带分为试验组和对照组,均为双侧经皮穿刺椎体成形术(Percutaneous Vertebroplasty,PVP),研究骨质致密带与骨水泥在椎体矢状面分布的关系。结果:共140例患者,涉及179个椎体,其中有117个椎体在术前CT矢状位和(或)冠状位重建可在骨折椎体内发现骨质致密带,CT未发现骨质致密带的椎体中,有21个椎体MRI矢状位重建中可发现致密带,这也是诊断椎体骨折的重要依据;138个椎体中共有75个在术中可发现初始骨水泥偏心分布于椎体上部或下部、骨水泥在椎体矢状面分布有不均分布现象,其界面与术前发现的椎体内骨质致密带的位置一致,典型情况下可出现椎体内骨质致密带的逆向铸型(骨水泥充盈缺损);未发现骨质致密带的41个椎体术中有5个出现骨水泥偏心分布现象,术中、术后复查可发现骨水泥在椎体矢状面分布有断层现象;试验组术中共有7个椎体因骨水泥在矢状面分布欠佳,二次调整工作通道,再次注入骨水泥,实现骨水泥在椎体内的良好分布。结论:新鲜骨质疏松性椎体压缩性骨折椎体内较广泛存在骨质致密带,可影响骨水泥在椎体矢状面分布,术前根据影像学资料了解椎体内骨质致密带在椎体内的位置,设计穿刺通道,使双侧通道分别建立在骨质致密带的两侧,进而实现骨水泥在矢状面良好分布;对于骨水泥在椎体矢状面分布不佳的,因为椎体内骨质致密带的存在,调整工作套管方向,突破椎体内Objective:To investigate the incidence of the osteodense zone in the fresh osteoporotic vertebral compression fracture(OVCF)and influence of the osteodense zone on the sagittal distribution of cement in the vertebral body.Methods:The data of preoperative plain radiographs,CT and MRI of 179 vertebral bodies,intraoperative C-arm machine imaging,and postoperative review of 140 patients diagnosed with fresh OVCF between January and December 2021 were retrospectively reviewed.Statistics incidence of the osteodense zones in the fractured vertebral bodies,and they were divided into test and control groups according to the presence or absence of osteodense zones.All patients underwent bilateral puncture percutaneous vertebroplasty(PVP)to investigate the relationship between the osteodense zone and the distribution of cement in the sagittal plane of the vertebral bodies.Results:A total of 140 patients,involving 179 vertebral bodies,including 117 in whom the osteodense zones could be found within the fractured vertebral bodies on preoperative CT sagittal and(or)coronal reconstruction,21 in whom the osteodense zones could not be found on CT,but the osteodense zone cound be found on sagittal reconstruction of MRI,were also important for diagnosing vertebral fractures.Five of 41 vertebrae without an osteodense zone showed an eccentric distribution of cement,and review intraoperatively and postoperatively revealed a tomographic distribution of cement in the sagittal plane of the vertebral bodies.A total of seven vertebral bodies were suboptimal distributed by cement in the sagittal plane,the working channel was secondarily adjusted,and cement was reinjected to achieve good distribution of cement in the vertebral bodies.Conclusion:The presence of the osteodense zones in the vertebral bodies of OVCF were widespread and can affect the distribution of cement in the sagittal plane of the vertebral bodies,preoperatively,based on the radiographic data,confirm the location of the osteodense zone in the vertebral body,puncture channels

关 键 词：骨质疏松症 椎体压缩性骨折 经皮穿刺椎体成形术 骨质致密带 骨水泥分布 

分 类 号：R683[医药卫生—骨科学]