术前CT三维重建评估骨质疏松性椎体压缩性骨折的临床价值  

Preoperative CT Three-Dimensional Reconstruction in Evaluating the Clinical Value of Osteoporotic Vertebral Compression Fractures

作　　者：李飞鹏 李强[1] 刘刚 章建卫[3] LI Feipeng;LI Qiang;LIU Gang;ZHANG Jianwei(Department of Intervention,First Hospital of Northwest University,Xi'an 710000,China;Department of Orthopedics,Daxing Hospital,Xi'an 710002,China;Department of Spinal Surgery,Taizhou Integrated Traditional Chinese and Western Medicine Hospital,Taizhou,Zhejiang 317523,China)

机构地区：[1]西北大学第一医院介入科,西安710000 [2]西安大兴医院骨一科,西安710000 [3]浙江省台州市中西医结合医院脊柱外科,浙江台州317523

出　　处：《转化医学杂志》2024年第5期723-726,743,共5页Translational Medicine Journal

基　　金：温岭市科技项目(2019S0180090)。

摘　　要：目的探究CT三维重建在骨质疏松性椎体压缩性骨折(OVCF)诊治中的应用价值。方法回顾性收集2021年1月至2022年11月西北大学第一医院收治的OVCF患者临床资料,以术中所见疼痛责任椎体为金标准,评估CT三维重建疼痛责任椎体的诊断效能;比较实际测量不同椎体术前CT三维重建测定的椎弓根宽度(POW)值;比较不同年龄、性别患者T_(11)~L_(5)脊椎的POW值,并评估手术治疗效果。结果本研究纳入70例符合入选标准的OVCF患者,共170个椎体。以经皮椎体成形术(PVP)或经皮椎体后凸成形术(PKP)治疗术中所见116个责任椎体为金标准,术前CT三维重建诊断责任椎体的敏感度、特异度、准确度分别为0.948、0.926、0.941。不同椎体术前CT三维重建测定的POW值差异存在显著统计学意义(P<0.05);除L1外,男性OVCF患者其他椎体的POW值均显著大于女性(P<0.05);年龄<75岁OVCF患者的T_(11)~L_(5)脊椎POW值均显著大于年龄≥75岁的患者(P<0.05)。70例患者手术平均时长(45.5±6.0)min,术中平均失血量(50.0±10.5)mL,术后发生骨水泥渗漏1例;术后疼痛视觉模拟评分法(VAS)和ODI评分均显著下降(P<0.05)。结论术前CT三维重建可有效测量POW值,评估手术治疗效果,对于OVCF患者责任椎体的诊断具有较大临床应用价值。Objective To explore the application value of CT 3D reconstruction in the diagnosis and treatment of osteoporotic vertebral compression fractures(OVCF).Methods The clinical data of 70 patients with OVCF admitted to the First Hospital of Northwest University from January 2021 to November 2022 were retrospectively collected.Using intraoperative findings of the painful vertebral body as the gold standard,the diagnostic efficacy of CT 3D reconstruction for identifying the painful vertebral body was evaluated.The pedicle outer width(POW)measured by CT 3D reconstruction of different vertebrae was compared.Compare the POW values of the spine from T_(11)to L_(5)in patients of different ages and genders,and evaluate the effectiveness of surgical treatment.Results This study included 70 patients with OVCF who met the inclusion criteria,with a total of 170 vertebrae.The gold standard for the diagnosis of the 116 responsible vertebrae during the treatment of PVP or PKP was the preoperative CT three-dimensional reconstruction,with sensitivity,specificity,and accuracy of 0.948,0.926,and 0.941,respectively.There was a significant statistical difference in the POW value determined by preoperative CT three-dimensional reconstruction for different vertebrae(P<0.05);except for L1,the POW value of male OVCF patients in other vertebrae was significantly greater than that of female patients(P<0.05).The spinal POW values of T_(11)~L_(5)in OVCF patients<75 years old were significantly higher than in those≥75 years old(P<0.05).The average operation duration of 70 patients was(45.5±6.0)min,the average intraoperative blood loss was(50.0±10.5)mL,and postoperative bone cement leakage occurred in 1 patient.Postoperative VAS and ODI scores significantly decreased(P<0.05).Conclusion Preoperative CT 3D reconstruction can effectively measure POW values,evaluate surgical outcomes,and has significant clinical application value for diagnosing responsible vertebrae in OVCF patients.

关 键 词：骨质疏松性椎体压缩性骨折 术前 CT三维重建 椎弓根宽度 

分 类 号：R683.2[医药卫生—骨科学]