术前多层电子计算机断层扫描最佳穿刺路径设计在经皮椎体后凸成形术中穿刺的应用价值

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摘要目的探讨术前多层电子计算机断层扫描（MSCT）最佳穿刺路径设计在经皮椎体后凸成形术（PKP）治疗胸腰椎骨质疏松性压缩骨折中的应用价值。方法选取2016年1月～2019年12月我院收治的（40例，46 椎）脆性压缩性骨折并行PKP 微创治疗患者，随机抽签分为实验组（20例，25 椎）与对照组（20例，21 椎）。实验组术前采用MSCT 设计最佳穿刺路径，对照组在C形臂透视下常规穿刺。比较两组的术中透视次数、手术时间、术中骨水泥弥散超过中线、术后患者腰背疼痛VAS评分。结果所有患者均顺利完成手术，实验组3例出现骨水泥渗漏，其中椎间隙渗漏1例，椎旁渗漏1例，椎前渗漏1例；对照组5例出现骨水泥渗漏，其中椎间隙渗漏1例，椎旁渗漏2例，椎前渗漏2例，均无严重并发症发生。实验组的手术时间短于对照组，C形臂曝光次数少于对照组，腰背疼痛VAS 低于对照组，差异有统计学意义（P＜0.05）；实验组的骨水泥弥散超中线的椎体数多于对照组，差异有统计学意义（P＜0.05）。结论对于胸腰椎脆性压缩性骨折患者，术前MSCT 设计最佳穿刺路径行PKP 术的骨水泥弥散效果优于单纯C形臂透视穿刺法，且明显减少了穿刺次数，缩短了手术时间，减少了医生和患者的射线暴露次数。该技术操作简单，安全性更高。

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	崔晓荣
	李世梁
	孙海东
	朱小明
	连育才
	李向阳
	李育敏
	武宁

关键词 ：压缩性骨折, 术前多层螺旋CT, 最佳路径设计, 穿刺点, 椎体后凸成形术

Abstract：Objective To explore the application value of the best puncture path design of preoperative multi-slice CT(MSCT) in percutaneous kyphoplasty (PKP) in the treatment of osteoporotic compression fracture of thoracolumbar spine in PKP.Methods From January 2016 to December 2019,40 patients (46 vertebrae) with brittle compression fractures and PKP minimally invasive treatment were selected and divided into the experimental group (20 cases,25 vertebrae)and the control group (20 cases,21 vertebrae) by random lot.MSCT was used to design the best puncture path in the experimental group before operation,while routine puncture was performed under C-arm fluoroscopy in the control group.The intraoperative fluoroscopy times,operation time,intraoperative bone cement dispersion over the midline,and postoperative VAS scores of low back pain were compared between the two groups.Results All patients successfully completed the operation.In the experimental group,there were 3 cases of bone cement leakage,including 1 case of vertebral space leakage,1 case of paravertebral leakage and 1 case of prevertebral leakage.In the control group,there were 5 cases of bone cement leakage,including 1 case of vertebral space leakage,2 cases of paravertebral leakage and 2 cases of prevertebral leakage,all of which had no serious complications.The operation time of the experimental group was shorter than that of the control group,the exposure times of C-arm of the experimental group was less than that of the control group,the vas of lumbago pain of the experimental group was lower than that of the control group,the differences were statistically significant (P ＜0.05).The mumb of cement diffuses beyond that midline cone in the experimental group was more than that in the control group,the difference was statistically significant (P ＜0.05).Conclusion For patients with thoracolumbar fragile compression fracture,the bone cement dispersion effect of PKP is better than that of C-arm fluoroscopy,and the number of puncture is significantly reduced,the operation time is shortened,and the number of radiation exposure of doctors and patients is reduced.The operation of this technology is simple and the safety is higher.

Key words： Compression fracture Preoperative multislice spiral CT Optimal path design Puncture point Percutenous kyphoplasty

基金资助:江西省卫生健康委中医药科研计划课题（2018A 250）；江西省赣州市科技计划项目（[2018]50 号）

作者简介: 崔晓荣（1982-），男，主治医师，研究方向：脊柱及肌骨影像诊断

引用本文:

崔晓荣；李世梁；孙海东；朱小明；连育才；李向阳；李育敏；武宁. 术前多层电子计算机断层扫描最佳穿刺路径设计在经皮椎体后凸成形术中穿刺的应用价值[J]. 中国当代医药, 2020, 27(31): 166-168.
CUI Xiao-rong；LI Shi-liang；SUN Hai-dong；ZHU Xiao-ming；Lian Yu-cai；LI Xiang-yang；LI Yu-min；WU Ning. Application value of the best puncture path design of preoperative multislice CT in puncture of percutaneous kyphoplasty. 中国当代医药, 2020, 27(31): 166-168.

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https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2020/V27/I31/166

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