摘要
目的经皮椎体成形术(PVP)前根据病变椎体的横断位和矢状位CT图像画出模拟穿刺路径、拟定手术方式,评价该方法的可行性。方法 58例椎体压缩性骨折患者(共63节椎体),PVP术前通过横断位和矢状位CT图像上应用画线法模拟穿刺路径并测量模拟穿刺参数,建立三维模拟穿刺路径以确定皮肤穿刺点和穿刺角度。模拟穿刺路径满足单侧入路条件者拟定手术行单侧入路,否则行双侧入路,观察该方法的临床疗效。采用视觉模拟评分(VAS)法分析患者术前及术后3个月疼痛缓解情况,统计学软件采用SPSS13.0,计量数据以(x±s)表示并用配对t检验。结果本组病例术前模拟穿刺结果显示不同椎体皮肤进针点及穿刺角度均不一致。所有患者根据术前确定的模拟穿刺路径均成功完成手术。所有椎体一次穿刺成功率为100%,其中55节椎体采用单侧入路,手术时间为(28.5±5.5)min,双侧入路为8节椎体,手术时间(37.5±5.5)min,术后患者的疼痛缓解率为100%,随访期间无严重并发症。结论PVP术前通过对病变椎体的横断位和矢状位CT图像分析,可以在术前明确单、双侧椎弓根入路术式,有助于提高一次穿刺的成功率和穿刺的安全性。
Objective To discuss the feasibility of using three-dimensional simulation positioning of puncture route that is sketched according to the transversal and sagittal CT images to design percutaneous vertebroplasty （PVP） plan. Methods A total of 58 patients with 63 diseased vertebral bodies were enrolled in this study. Before PVP, the simulation puncture route was delineated according to the transversal and sagittal CT images, and the simulation puncture parameters were determined by using the software of PACS, in this way the three-dimensional simulation puncturing route was established , and the skin needle entry point as well as the puncture angle were calculated. Unilateral transpedicular approach was used when the simulation puncture route could meet the requirements of unilateral approach. Otherwise , bilateral transpedicular approach would be employed. Three months after PVP visual analogue score （VAS） was used to evaluate the degree of pain relief, and the result was compared with that determined before PVP. SPSS 13.0 software was used for statistical analysis. The estimating data were statistically analyzed with paired t-test and the results were expressed in the form of （x ± s）. Results The measurement results showed that significant differences in the puncture angles and skin needle entry points existed between different vertebral bodies. Guided by the preoperatively determined simulation puncture route , PVP was successfully accomplished in all patients. The success rate of single puncturing was 100% （63 vertebral bodies in total）. Among 63 vertebral bodies, unilateral transpedicular approach was adopted in 55 and the operation time was （28.5 ± 5.5） minutes, while bilateral transpedicular approach was carried out in 8 and the operation time was （37.5 ± 5.5） minutes. After PVP, complete pain relief was achieved in all patients. No serious＆nbsp;complications occurred during the follow-up period. Conclusion Three-dimensional simulation positioning of puncture route that is sketched according to preoperative transversal and sagittal CT images is very useful in precisely determining the puncturing route before PVP, which is very helpful to increase the success rate of single puncture and to improve the procedural safety.
出处
《介入放射学杂志》
CSCD
北大核心
2014年第6期532-535,共4页
Journal of Interventional Radiology
基金
2011年度镇江市科技支撑计划(社会发展)指导性项目(FZ2011046)
关键词
经皮椎体成形术
穿刺路径
三维定位
CT图像
percutaneous vertebroplasty
puncturing approach
three-dimensional positioning
CT image
