CT与透视引导下椎体成形术比较

Comparison of percutaneous vertebroplasty under guidance of CT versus fluoroscopy

摘要:

[目的] 比较经CT 与经透视引导下椎体成形术（percutaneous vertebroplasty, PVP） 治疗老年骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture, OVCF） 的临床效果。[方法] 2019 年5 月—2021 年5 月80 例行PVP 手术治疗的老年OVCF 患者纳入本研究，采用抽签法随机将患者分为两组，40 例经CT 引导下完成PVP 操作（CT 组），另40 例经C 形臂X 线机透视引导下完成PVP 操作（透视组）。比较两组围手术期及影像资料。[结果] 所有患者均顺利完成手术，CT 组手术时间[(45.6±1.7) min vs (69.2±2.0) min, P＜0.001]、术中X 线曝光次数[(16.8±0.9) 次vs (38.6±2.6) 次, P＜0.001]、穿刺时间[(23.2±1.5)min vs (46.2±2.1) min, P＜0.001] 均显著少于透视组，一次穿刺成功率[例(%), 32 (80.0) vs 26 (65.0), P＜0.001] 显著高于透视组。两组骨水泥渗漏率的差异无统计学意义（P＞0.05）。随访时间2~12 个月，与术前相比，两组出院时VAS、ODI 评分均显著减少（P＜0.05），相同时间点，两组间VAS、ODI 评分的差异均无统计学意义（P＞0.05）。影像方面，出院时两组患者的椎体前缘高度（an-terior vertebral height, AVH） 和局部后凸角（local kyphotic angle, LCA） 的差异均无统计学意义（P＞0.05）。[结论] CT 引导穿刺准确率更高，可显著缩短手术时间、减少术中透视次数，实时监控骨水泥注射过程。对于重度骨质疏松的高龄患者，优势显著。

Abstract:

[Objective] To compare the clinical efficiency of percutaneous vertebroplasty (PVP) under guidance of CT versus fluorosco-py for osteoporotic vertebral compression fracture (OVCF) in the elderly. [Methods] From May 2019 to May 2021, 80 elderly patients withOVCF who underwent PVP surgery were included in this study, and randomly divided into two groups by lottery. Of them, 40 patients hadPVP performed under CT (CT group), while the other 40 patients underwent PVP under fluoroscopy with C-arm X-ray machine (fluoroscopygroup). The documents regarding perioperative period and images were compared between the two groups. [Results] All patients in bothgroups had PVP performed successfully. The CT group proved significantly superior to the fluoroscopy group in terms of operation time[(45.6±1.7) min vs (69.2±2.0) min, P＜0.001], intraoperative X-ray exposure times [(16.8±0.9) vs (38.6±2.6), P＜0.001] and puncture time[(23.2±1.5) min vs (46.2±2.1) min, P＜0.001], and success rate of first puncture [cases (%), 32 (80.0) vs 26 (65.0), P＜0.001]. However, therewas no significant difference in bone cement leakage rate between the two groups (P＞0.05). All the patients were followed up for 2 to 12months, and the VAS and ODI scores were significantly decreased in both groups at discharge compared with those before surgery (P＜0.05),whereas which were not statistically significant between the two groups at any time points accordingly (P＞0.05). Regarding imaging, therewere no significant differences in anterior vertebral height (AVH) and local kyphotic angle (LCA) between the two groups at discharge (P＞0.05). [Conclusion] The CT-guided PVP does significantly shorten the operation time, reduce the number of intraoperative fluoroscopy, andmonitor the bone cement injection process in real time, might take more advantage for the elderly with severe osteoporosis.