ECT辅助定位PKP术治疗骨质疏松性椎体骨折的应用

Application of ECT-Assisted Localization PKP in the Treatment of Osteoporotic Vertebral Fracture

摘要: 目的：因部分患者自身、瓣膜具有心脏起搏器置换、支架和假牙等，在临床中无法行MRI检查，本次主要研究骨质疏松性椎体压缩骨折患者中发射型计算机断层扫描仪(Emission Computed Tomography, ECT)辅助定位经皮椎体后凸成形术(percutanous kyphoplasty, PKP)治疗的应用价值。方法：选取2017年12月至2019年5月延安大学附属医院收治的24例临床被确诊为骨质疏松性椎体骨折的患者，所有患者家属均已同意并签署有创知情同意书，年龄约63~92岁，首先将全部患者经查体定位、术前X线和CT筛查，模拟所有患者不能进行MRI检查，将病变的椎体再用ECT辅助定位，确定新鲜压缩骨折的责任椎体数目，然后行PKP手术治疗。结果：手术顺利，术后复查无骨水泥渗漏、发生感染、下肢静脉栓塞等术后并发症。ECT确定的责任椎体数目为45节，确定为新鲜骨折的责任椎体数目为32个。术中手术时间平均为(44.54 ± 5.29) min，术中X线透视次数平均为(11.69 ± 3.62)次，骨水泥量平均为(3.48 ± 1.15) ml。比较术前和术后VAS评分、伤椎椎体前缘高度、后凸Cobb角均有改善。结论：说明ECT所引导的PKP手术对骨质疏松性椎体骨折有明显的疗效。

Abstract: Objective: Because some patients have cardiac pacemakers, valve replacements, stents and dentures, MRI cannot be performed clinically. This study focuses on the application value of Emission Computed Tomography (ECT) assisted localization percutanous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fracture. Methods: From December 2017 to May 2019, 24 patients aged 63 - 92 years old with osteoporotic vertebral fracture, whose families have agreed and signed an invasive informed consent form, were selected from the Affiliated Hospital of Yan’an University. First all patients underwent physical examination and localization, preoperative X-ray and CT screening, and simulate that all patients could not undergo MRI examination. Then, the diseased vertebral bodies were located with ECT assistance to determine the number of responsible vertebral bodies for fresh compressed fractures, and then PKP surgery was performed. Results: The operation went smoothly. There was no leakage of bone cement, infection, venous embolism of lower limbs and other postoperative complications. The number of responsible vertebral bodies determined by ECT is 45, and the number of responsible vertebral bodies determined as fresh fractures is 32. The average operative time was (44.54 ± 5.29) min, the average number of X-ray fluoroscopy was (11.69 ± 3.62) and the average amount of bone cement was (3.48 ± 1.15) ml. The VAS score, anterior height of injured vertebral body and Cobb angle of kyphosis before and after operation are all improved. Conclusion: ECT-guided PKP operation has an obvious curative effect on osteoporotic vertebral body fracture.