| 腰椎定量CT对骨质疏松性胸腰椎骨折行椎体成形术的指导意义 |
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投稿时间：2019-03-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 孙振国 |
SUN Zhen-guo |
湖州市第一人民医院骨科, 浙江 湖州 313000 |
Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou 313000, Zhejiang, China |
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| 杨红航 |
YANG Hong-hang |
湖州市第一人民医院骨科, 浙江 湖州 313000 |
Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou 313000, Zhejiang, China |
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| 李恒 |
LI Heng |
湖州市第一人民医院骨科, 浙江 湖州 313000 |
Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou 313000, Zhejiang, China |
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| 翁伟 |
WENG Wei |
湖州市第一人民医院骨科, 浙江 湖州 313000 |
Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou 313000, Zhejiang, China |
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| 闵继康 |
MIN Ji-kang |
湖州市第一人民医院骨科, 浙江 湖州 313000 |
Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou 313000, Zhejiang, China |
214983663@qq.com |
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| 期刊信息：《中国骨伤》2020年，第33卷，第2期，第111-115页 |
| DOI：10.12200/j.issn.1003-0034.2020.02.004 |
| 基金项目:浙江省自然科学基金资助项目（编号：LY14H060001）；湖州市科技局公益性技术应用研究（编号：2015GYB25） |
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中文摘要:
目的：探究腰椎定量CT（QCT）对骨质疏松性胸腰椎骨折行椎体成形术的指导意义。
方法：对2017年12月至2018年12月采用经皮穿刺椎体成形术治疗的90例骨质疏松性胸腰椎压缩性骨折患者进行回顾性分析，其中男24例，女66例；年龄（74.47±6.60）岁。90例患者术前均进行腰椎QCT测定，根据腰椎QCT值分为3组：骨量减少组（80~120 g/L，17例，30个椎体），骨质疏松组（40~80 g/L，44例，66个椎体）及严重骨质疏松组（<40 g/L，29例，39个椎体）。术中向椎体内注射骨水泥及正侧位C形臂X线透视，观察不同QCT值患者的骨水泥在伤椎内的弥散分布及渗漏情况，对于骨水泥弥散超过椎体中线患者采用单侧入路术式，相反则采用双侧入路术式，分析腰椎QCT值对骨质疏松性胸腰椎骨折行椎体成形术穿刺方法的指导意义。
结果：90例135个椎体中，共有72例98个椎体骨水泥弥散超过中线，占72.59%。骨水泥弥散超过椎体中线的患者采用单侧入路术式，其中骨量减少组有5例8个椎体、骨质疏松组有40例55个椎体，严重骨质疏松组有27例35个椎体；且3组患者间骨水泥弥散效果比较差异有统计学意义（χ2=41.397，P=0.000）；此外，骨量减少组患者未发生骨水泥渗漏，骨质疏松组有3例4个椎体发生渗漏，严重骨质疏松组有2例3个椎体发生骨水泥渗漏，但发生骨水泥渗漏的患者均未造成神经损伤等症状，且3组患者间骨水泥渗漏比较差异无统计学意义（χ2=2.242，P=0.326）。
结论：根据患者腰椎QCT检测明确患者骨质疏松程度，指导进行穿刺方法，可缩短手术时间，减少透视次数，有效提高椎体成形术的安全性。 |
| 【关键词】骨质疏松 椎体骨折 腰椎定量CT 椎体成形术 骨水泥 |
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| Guiding significance of lumbar quantitative computed tomography in percutaneous vertebroplasty for osteoporotic vertebral compression fractures |
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ABSTRACT
Objective: To investigate the guiding significance of lumbar quantitative computed tomography(QCT) in percutaneous vertebroplasty (PKP) for osteoporotic vertebral compression fractures(OVCF).
Methods: The clinical data of 90 patients with OVCF underwent PKP from December 2017 to December 2018 were retrospectively analyzed. There were 24 females and 66 males,with an average aged of (74.47±6.60) years old. All patients were received QCT examination before surgery,and according to the QCT value of lumbar spine,the patients were divided into osteopenia decrease group(80 to 120 g/L,17 cases,30 vertebrae),osteoporosis group(40 to 80 g/L,44 cases,66 vertebrae)and severe osteoporosis group(<40 g/L,29 cases,39 vertebrae). Bone cement was injected into vertebral body,AP and lateral X-rays were done during operation. The diffusion and leakage of bone cement in injured vertebrae of patients with different QCT values were observed. Unilateral approach was used for patients whose bone cement diffused beyond the midline of the vertebral body,otherwise,and bilateral approach was adopted,and guiding significance of QCT in PKP for OVCF was analyzed.
Results: In 90 cases of 135 vertebrae,72 cases of 98 vertebral bone cement diffused beyond the midline,accounting for 72.59%. Unilateral approach was used for the 72 patients whose bone cement diffused beyond the midline of the vertebral body,among them,there were 5 cases with 8 vertebrae in osteopenia group,40 cases with 55 vertebrae in osteoporosis group and 27 cases with 35 vertebrae in severe osteoporosis group. There was significant difference in the bone cement dispersion between three groups(χ2=41.397,P=0.000). Moreover,no bone cement leakage occurred in osteopenia group,3 cases of 4 vertebrae occurred in osteoporosis group and 2 cases of 3 vertebrae in severe osteoporosis group. However,none of the patients with bone cement leakage caused nerve injury and other symptoms,and there was no significant difference in bone cement leakage between the three groups (χ2=2.242,P=0.326).
Conclusion: According to the QCT examination of lumbar spine,defining the degree of osteoporosis and guiding the puncture method can shorten the operation time,reduce the number of fluoroscopy,and effectively improve the safety of vertebroplasty. |
| KEY WORDS Osteoporosis Vertebral fracture Lumbar quantitative computed tomography Percutaneous vertebroplasty Bone cement |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 孙振国,杨红航,李恒,翁伟,闵继康.腰椎定量CT对骨质疏松性胸腰椎骨折行椎体成形术的指导意义[J].中国骨伤,2020,33(2):111~115 |
| 英文格式: | SUN Zhen-guo,YANG Hong-hang,LI Heng,WENG Wei,MIN Ji-kang.Guiding significance of lumbar quantitative computed tomography in percutaneous vertebroplasty for osteoporotic vertebral compression fractures[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(2):111~115 |
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