标题：三维CT引导下行上胸椎活检及经皮椎体成形术的临床应用效果

      作者：徐准，晏怡果，王文军，王程，李学林，薛静波    (南华大学附属第一医院脊柱外科，湖南 衡阳 421001)

      卷次： 2018年29卷20期

      【摘要】 目的 探讨三维CT引导下行上段胸椎椎体活检及经皮椎体成形术的疗效和并发症。方法 2015年6月至2017年11月南华大学附属第一医院脊柱外科对20例上胸椎骨折(T1~5)患者(共涉及26节椎体)在三维CT的引导下行椎体穿刺活检术以及在遥控骨水泥自动推进器下行经皮椎体成形术。观察活检的结果、骨水泥的注射量及注射的并发症，采用视觉模拟量表 (VAS)进行疼痛评分，比较患者术前、术后VAS评分结果。结果 20例患者均能成功取出组织进行活检，其中5例活检结果为骨质疏松性骨折，15例为转移瘤，为肿瘤患者的进一步治疗提供了病理学依据；骨水泥注入量为 (2.6±1.2) mL，骨水泥渗漏率约为11.5%，无肺栓塞及肢体感觉功能障碍等并发症发生；患者术后VAS评分为(3.4±1.9)分，明显低于术前的(6.6±2.4)分，差异有统计学意义(P<0.05)。结论 三维CT引导下，能精准地进行上段胸椎的活检及经皮椎体成形术，疗效满意，且安全性较高。
      【关键词】 三维CT；上段胸椎；活检；椎体成形术
      【中图分类号】 R687.3 【文献标识码】 A 【文章编号】 1003—6350（2018）20—2850—04

Clinical effect of upper thoracic vertebral biopsy and percutaneous vertebroplasty under three-dimensionalCT-guidance.
XU Zhun, YAN Yi-guo, WANG Wen-jun, WANG Cheng, LI Xue-lin, XUE Jing-bo. Department of SpineSurgery, the First Affiliated Hospital of University of South China, Hengyang 421001, Hunan, CHINA
【Abstract】 Objective To discuss the clinical outcomes and complications of upper thoracic vertebral biopsyand percutaneous vertebroplasty under three-dimensional CT-guidance. Methods From June 2015 to November 2017,20 patients with 26 cases of upper thoracic vertebrae fractures (T1-5) had undergone vertebral biopsy and percutaneousvertebroplasty with the bone cement automatic propulsion under the guidance of three-dimensional CT in Department ofSpine Surgery of the First Affiliated Hospital of University of South China. The results of biopsy, the injection doses ofbone cement and the complications were observed. Besides, the clinical outcomes were assessed in terms of Visual Ana-logue Scale (VAS), and VAS score of the pro-operation with the post-operation were compared. Results All 20 cases ofpatients had the tissues successfully removed for biopsies. The results of 5 cases were osteoporotic fractures and theother results were metastatic tumors, which provided pathological basis for the further treatments of patients with can-cer. The average injection dose of bone cement was (2.6±1.2) mL. The leakage rate of bone cement was 11.5%, andthere were no other complications such as pulmonary embolism and paralysis. The VAS score of the pro-operation was(6.6±2.4) versus (3.4±1.9) of the post-operation (P<0.05). Conclusion The upper thoracic biopsy and percutaneous ver-tebroplasty can be carried out accurately under three-dimensional CT guidance. The outcomes are satisfied and the proce-dures are safe.
      【Key words】 Three-dimensional CT; Upper thoracic vertebral; Biopsy; Vertebroplasty·论 著·doi:10.3969/j.issn.1003-6350.2018.20.012基金项目：湖南省卫生计生委科研计划课题项目(编号：C20180213、B20180154)；湖南省卫生计生委科研计划课题重点项目(编号：A2017016)