摘要
目的探讨数字平板探测器三维旋转血管造影(3D-RA)重建功能在椎体成形术中的应用价值。方法60例共103节椎体压缩性骨折患者,在椎体成形术前、进针过程中、及注入骨水泥后分别行三维旋转采集并立即作三维重建,以观察椎弓根、椎体形态及骨皮质的完整程度,进针针尖的方向和位置,观察骨水泥在椎体内的分布情况以及骨水泥的渗漏情况。结果所有病例中2例椎弓根不完整,2例椎体后缘不完整。进针过程中2例穿破椎弓根皮质,2例针尖穿破椎体前缘皮质,术中重新调整针尖方向。注入骨水泥后三维重建发现6例椎管内漏,8例椎间盘漏及椎旁漏。所有病例均未经外科手术治疗。结论椎体三维重建(3D-RA)在PVP术前可以指导进针,术中可观察进针方向和位置,术后可观察骨水泥在椎体内的分布情况及骨水泥渗漏情况,特别是在下颈椎、上胸椎的PVP术中有较大的应用价值。
Objective To evaluate the application of digital flat plate detector three-dimensional rotational angiography （3D-RA） reconstruction in percutaneous vertebroplasty （PVP）. Methods 103 vertebral bodies of 60 patients with compressed fracture were performed with rotational acquisition and 3D reconstruction before, during and after percutaneous vertebroplasty. The integrity of vertebral pedicle and bone cortex, the position and direction of the needles, the distribution and extravasation of cement were observed respectively. Results The incompleteness of 2 cases of pedicle of vertebral arch and 2 cases of posterior vertebral margin was found preoperatively. The cortical bone of 2 cases of vertebral pedicle and 2 cases of anterior vertebral margin were penetrated by needle during the operation. The direction of needle was adjusted subsequently. It was shown that bone cement extravasated into spinal canal in 6 cases, into intervertebral disc and paravertebral soft tissue in 8 cases after three-dimensional RA reconstruction. None of cases was treated surgically. Conclusion 3D-RA reconstruction can guide the puncture, determine the location of needle, and display the distribution and extravasation of bone cement in PVP, especially in PVP of the upper thoracic vertebrae and the lower cervical vertebrae.
出处
《当代医学》
2009年第11期236-238,共3页
Contemporary Medicine
关键词
经皮椎体成形术
骨水泥
渗漏
3D-RA
percutaneous vertebroplasty, bone cement, extravasation, 3D-RA
