| 三维CT及影像学分型在骨质疏松骨折椎体成形术中的应用 |
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Received:October 18, 2018
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| 作者 | Author | 单位 | Unit | E-Mail |
| 王成胜 |
WANG Cheng-sheng |
临朐县人民医院, 山东 临朐 262600 |
Linqu People's Hospital of Shandong, Linqu 262600, Shandong, China |
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| 刘爱国 |
LIU Ai-guo |
临朐县人民医院, 山东 临朐 262600 |
Linqu People's Hospital of Shandong, Linqu 262600, Shandong, China |
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| 刘成洲 |
LIU Cheng-zhou |
临朐县人民医院, 山东 临朐 262600 |
Linqu People's Hospital of Shandong, Linqu 262600, Shandong, China |
liuchengzhou@126.com |
| 田军 |
TIAN Jun |
山东省医学影像学研究所, 山东 济南 250000 |
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| 期刊信息：《中国骨伤》2019年32卷，第7期，第635-640页 |
| DOI：10.3969/j.issn.1003-0034.2019.07.010 |
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目的：探讨三维CT及影像学分型在骨质疏松性椎体压缩骨折（OVCFs）患者经椎体成形术（PVP）治疗中的应用。
方法：选取2016年4月至2018年3月在山东省临朐县人民医院住院行PVP治疗的90例OVCFs患者作为研究对象，其中男31例，女59例；年龄63~84（72.33±10.12）岁。对患者进行骨矿物质密度测量以确认骨质疏松症的存在，并且进行成像检查以确认椎体骨折的存在。术前通过MRI抑脂像确定骨折的区域，并进行三维建模，计算骨折区域的体积。于PVP术后对骨折区域内的骨水泥进行三维CT成像，应用计算机辅助设计软件，计算骨水泥在骨折区的体积比，然后分组研究。骨水泥在骨折区的体积比<50%的患者为对照组（41例）；骨水泥在骨折区的体积比≥ 50%的患者为观察组（49例）。观察两组患者术前、术后1 d、术后3个月的的疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI），记录两组患者的骨水泥用量。
结果：所有患者顺利完成手术，对照组发生骨水泥渗漏3例，观察组4例，患者均无明显临床症状。术后持续观察并随访3个月，无邻近椎体骨折、感染、骨水泥移位等并发症出现。两组患者骨水泥用量及骨水泥渗漏比较差异无统计学意义（P>0.05）。两组患者术前VAS和ODI评分比较差异无统计学意义（P>0.05）；术后1 d两组患者的VAS和ODI评分均显著降低（P<0.05），并且观察组下降更明显（P<0.05）；术后3个月ODI和VAS评分两组差异无统计学意义（P>0.05），可能与术后3个月左右椎体骨折已基本愈合，疼痛不再明显有关。
结论：PVP可明显改善OVCFs的临床症状，骨折区域的骨水泥填充情况是影响PVP术后近期疗效的关键。 |
| [关键词]:骨质疏松性椎体压缩骨折 计算机辅助三维成像 骨水泥分布 |
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| Application of three-dimensional CT and image classification in percutaneous vertebraplasty for osteoporotic vertebral compression fractures |
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Abstract:Objective:To explore the application of three-dimensional CT and image classification in the treatment of osteoporotic vertebral compression fracture(OVCFs) by percutaneous vertebroplasty(PVP).
Methods:A total of 90 patients with OVCFs who were treated with PVP in Linqu People's Hospital of Shandong Province from April 2016 to March 2018 were selected as subjects. There were 31 males and 59 females,aged from 63 to 84 years old. Bone mineral density measurements were performed in all patients to confirm the presence of osteoporosis and imaging examinations were performed to confirm the presence of vertebral fractures. The fracture area was determined by MRI fat surpressed image before operation and three-dimensional modeling was performed to calculate the volume of fracture area. Three dimensional CT imaging of bone cement in fracture area was performed after PVP and the volume ratio of bone cement in fracture area was calculated by computer aided design software,by which patients were divided into groups for study. Forty-one patients whose volume ratio of bone cement in fracture area less than 50% are control group and the rest of 90 patients are observation group. Visual analogue scale (VAS) and Oswestry Disability Index(ODI) were collected in two groups before operation and 1 day,3 months after operation. The amount of bone cement was recorded after operation.
Results:All operations were successful. There were 3 cases of cement leakage in control group and 4 cases in observation group. All patients had no obvious clinical symptoms. After continuous observation and follow-up for 3 months,no complications such as adjacent vertebral fracture,infection,bone cement displacement were found. There was no significant difference in bone cement doses and bone cement leakage between two groups(P>0.05). There was no significant difference in preoperative VAS and ODI between two groups(P>0.05). All VAS and ODI obviously decreased(P<0.05) at 1 day after operation and in observation group the decrease was more significant (P<0.05). At 3 months after operation there was no significant difference between two groups. This may have been due to basically healing of vertebral fractures at 3 months after surgery and the pain was no longer significantly related.
Conclusion:PVP can significantly improve clinical symptoms of OVCFs and bone cement filling in fracture area is the key to the short-term effect of PVP. |
| KEYWORDS:Osteoporotic vertebral compression fractures Computer-assisted three-dimensional imaging Bone cement distribution |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 王成胜,刘爱国,刘成洲,田军.三维CT及影像学分型在骨质疏松骨折椎体成形术中的应用[J].中国骨伤,2019,32(7):635~640 |
| 英文格式: | WANG Cheng-sheng,LIU Ai-guo,LIU Cheng-zhou,TIAN Jun.Application of three-dimensional CT and image classification in percutaneous vertebraplasty for osteoporotic vertebral compression fractures[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(7):635~640 |
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