椎弓根穿刺椎体后凸成形术后穿刺通路的CT评价
发布时间：2019-01-04 10:26
【摘要】：目的:通过多层螺旋CT扫描(Multi-Slice CT,MSCT)及多平面重组(Multi-planar Reformation,MPR)观察经皮穿刺椎体后凸成形术(Percutaneous Kyphoplasty,PKP)后椎弓根穿刺的安全性与准确性。方法:回顾性分析泸州医学院脊柱外科2005年1月~2014年12月行PKP术治疗的胸腰椎压缩性骨折患者945例。根据病例纳入标准,最终784例共823个手术椎体纳入研究范围,男108例,女676例,年龄58岁~84岁,平均71.8岁。所有PKP手术均在C型臂X线机全程透视下完成,手术均由具有多年手术经验的高年资医生完成,术后2~4天手术椎体均行MSCT扫描及MPR。通过分析手术椎体的术后多平面重组CT图像,观察穿刺通路与椎弓根骨壁之间的位置关系,记录穿刺器械穿破椎弓根内壁的数目和位置。在CT横轴位图像上测量穿刺通路至椎弓根内壁内缘的距离,将内侧壁穿破(Medial Cortical Perforation,MCP)分为4级:I级椎弓根内侧皮质断裂或移位但穿刺通路未进入椎管,II级穿刺通路进入椎管0~2.0 mm,III级穿刺通路进入椎管2.1~4.0 mm,IV级穿刺通路进入椎管≥4.1mm。记录各级患者术中、术后的相关并发症。结果:784例共823个手术脊椎,穿刺通路完全位于椎弓根内679例共713个椎体,穿刺成功率为86.6%。105例共110个脊椎(13.4%)的椎弓根内壁被穿破,本研究中无椎间孔穿破的病例。结合分级、椎弓根毗邻解剖结构以及穿刺相关并发症,将椎弓根MCP分为可接受的穿破(Acceptable Perforation,AP),包括I级和II级;不可接受的穿破(Unacceptable Perforation,UAP),包括III级和IV级。在总体穿刺中:I级占1.5%(12/823),II级占8.4%(69/823),III级占2.9%(24/823),IV级占0.6%(5/823)。110个椎弓根内壁穿出距离总体呈正偏态分布(Positive Skewness Distribution,PSD),即绝大多数MCP为AP,占穿破总数的73.6%(81/110),其中I级占10.9%,II级占62.7%,穿刺通路骨水泥渗漏(Bone Cement Leakage,BCL)至椎管2例,其余均未出现穿刺相关并发症;少数MCP为UAP,占穿破总数的26.4%(29/110),其中III级占21.8%,IV级占4.5%,穿刺通路骨水泥渗漏至椎管3例,脑脊液(Cerebrospinal Fluid,CSF)漏14例,一过性神经根支配区域麻木疼痛11例,神经根损伤1例,硬膜外血肿1例,无内壁穿出距离超过5.0mm和脊髓损伤(Spinal Cord Injury,SCI)病例。结论:1、MSCT及MPR能准确评价穿刺通路在椎弓根内的位置。2、在总体穿刺中:椎弓根内壁穿破的发生率为13.4%(110/823),I级12个(1.5%),II级69个(8.4%),III级24个(2.9%),IV级5个(0.6%)。胸椎的内壁穿破率高于腰椎。3、绝大多数MCP为AP,占穿破总数的73.6%(81/110),少数MCP为UAP,占穿破总数的26.4%(29/110),无穿出距离超过5.0mm病例。4、在临床实际操作中,椎弓根内壁穿破损伤并不少见,分级程度越高,硬膜囊、神经根、脊髓损伤的可能性越大。5、新的分级、分类系统紧密的结合了影像、解剖和临床,能为手术操作和临床疗效及并发症的评估提供参考。
[Abstract]:Objective: to observe the safety and accuracy of pedicle puncture after percutaneous kyphoplasty (Percutaneous Kyphoplasty,PKP) by multislice spiral CT scanning (Multi-Slice CT,MSCT) and multiplanar recombination (Multi-planar Reformation,MPR). Methods: a retrospective analysis of 945 cases of thoracolumbar vertebral compression fractures treated by PKP from January 2005 to December 2014 was performed in spine surgery of Luzhou Medical College. According to the inclusion criteria, 823 vertebrae were included in 784 cases, 108 males and 676 females, ranging in age from 58 to 84 years (mean 71.8 years). All PKP operations were performed under the fluoroscopy of the C-arm X-ray machine. The operation was performed by an elderly doctor with many years of experience. The vertebral body was scanned with MSCT and MPR. 2 and 4 days after operation. The relationship between the puncture pathway and the pedicle bone wall was observed by analyzing the multiplanar reconstructed CT images of the surgical vertebrae, and the number and location of the puncture instrument perforating the internal wall of the pedicle were recorded. The distance between the puncture pathway and the inner edge of the pedicle wall was measured on the CT axial image. The medial cortex of the pedicle was broken or shifted but the puncture pathway did not enter the spinal canal, the medial cortex of the pedicle was broken or shifted in the grade I, and the medial wall of the pedicle was broken through the inner edge of the pedicle wall. The II grade puncture pathway entered the spinal canal 0. 0 mm,III level and entered the spinal canal 2. 1 ~ 4. 0 mm,IV puncture pathway into the spinal canal 鈮，
本文编号：2400148
[Abstract]:Objective: to observe the safety and accuracy of pedicle puncture after percutaneous kyphoplasty (Percutaneous Kyphoplasty,PKP) by multislice spiral CT scanning (Multi-Slice CT,MSCT) and multiplanar recombination (Multi-planar Reformation,MPR). Methods: a retrospective analysis of 945 cases of thoracolumbar vertebral compression fractures treated by PKP from January 2005 to December 2014 was performed in spine surgery of Luzhou Medical College. According to the inclusion criteria, 823 vertebrae were included in 784 cases, 108 males and 676 females, ranging in age from 58 to 84 years (mean 71.8 years). All PKP operations were performed under the fluoroscopy of the C-arm X-ray machine. The operation was performed by an elderly doctor with many years of experience. The vertebral body was scanned with MSCT and MPR. 2 and 4 days after operation. The relationship between the puncture pathway and the pedicle bone wall was observed by analyzing the multiplanar reconstructed CT images of the surgical vertebrae, and the number and location of the puncture instrument perforating the internal wall of the pedicle were recorded. The distance between the puncture pathway and the inner edge of the pedicle wall was measured on the CT axial image. The medial cortex of the pedicle was broken or shifted but the puncture pathway did not enter the spinal canal, the medial cortex of the pedicle was broken or shifted in the grade I, and the medial wall of the pedicle was broken through the inner edge of the pedicle wall. The II grade puncture pathway entered the spinal canal 0. 0 mm,III level and entered the spinal canal 2. 1 ~ 4. 0 mm,IV puncture pathway into the spinal canal 鈮，
本文编号：2400148
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