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目的:探讨DynaCT在经皮穿刺椎体成形术治疗椎体转移性肿瘤中的应用价值。方法:2006年12月～2008年1月共收治伴有不同程度腰背部疼痛的椎体转移性肿瘤患者12例,年龄42～77岁,平均54.7岁。病变椎体共计14个,其中胸椎5个,腰椎9个,CT提示均有溶骨性破坏。均行经皮椎体成形术治疗,术前采用DynaCT技术成像观察椎体骨皮质连续性并和螺旋CT扫描比较,术中采用DynaCT技术成像帮助引导进针,术后根据WHO标准观察镇痛效果,分别使用DynaCT和螺旋CT观察骨水泥渗漏情况,并进行比较。结果:术前DynaCT和螺旋CT扫描显示骨皮质完整情况完全一致,共9个椎体10处骨皮质不连续,其中9处为骨皮质破坏、1处为粗大引流静脉。14个椎体中,8个行单侧椎弓根穿刺注射,6个行双侧椎弓根穿刺注射,均穿刺成功。每个椎体骨水泥注射量2.0～6.0ml,平均3.6ml。术后8例患者疼痛完全缓解(CR),4例部分缓解(PR),有效率100%。DynaCT和螺旋CT重建图像显示的骨水泥渗漏情况完全一致,14个椎体中10个出现骨水泥渗漏,其中3个渗漏至椎旁软组织,4个渗漏入椎旁静脉丛,1个渗漏至椎间隙,1个渗漏入椎管,1个同时渗漏至椎旁静脉丛和椎间隙,渗漏率71.4%,但无1例出现相关症状。10处骨皮质不连续中6处出现骨水泥渗漏。结论:应用DynaCT引导可以确保穿刺准确性,观察骨皮质连续性和骨水泥渗漏的作用和螺旋CT相同。
Objective: To investigate the value of DynaCT in the treatment of vertebral metastatic tumor by percutaneous vertebroplasty. Methods: From December 2006 to January 2008, 12 patients with vertebral metastatic tumors with varying degrees of back pain were aged from 42 to 77 years (average 54.7 years). Vertebral body lesions a total of 14, of which 5 thoracic vertebra, lumbar 9, CT tips are osteolytic destruction. All patients underwent percutaneous vertebroplasty were treated with DynaCT before operation to observe the cortical continuity of the vertebral body. Compared with spiral CT, intraoperative DynaCT imaging was used to help guide the needle insertion. The postoperative analgesic effect was observed according to the WHO standard, DynaCT and spiral CT were used to observe the leakage of bone cement, and compared. Results: Preoperative DynaCT and spiral CT scans showed that the integrity of cortical bone was exactly the same. There were 10 cortical bone discontinuities in 9 vertebrae, of which 9 were cortical bone destruction and 1 was drained veins. Of the 14 vertebral bodies, 8 were treated with unilateral pedicle puncture and 6 with bilateral pedicle puncture, all with successful puncture. Per vertebral bone cement injection volume 2.0 ~ 6.0ml, an average of 3.6ml. Postoperative pain relief in 8 patients (CR), 4 cases of partial response (PR), the effective rate of 100%. DynaCT and spiral CT reconstructed images showed exactly the same bone cement leakage, 10 of 14 vertebral bodies showed leakage of cement, 3 of them leaked into paravertebral soft tissue, 4 leaked into paravertebral venous plexus, 1 A leakage to the intervertebral space, a leakage into the spinal canal, one at the same time leakage to the paravertebral venous plexus and intervertebral space, the leakage rate of 71.4%, but no one case of related symptoms. 10 bone cortical discontinuity in 6 place cement leakage. CONCLUSIONS: The accuracy of puncture can be ensured by using DynaCT guidance. The effect of observing cortical continuity and bone cement leakage is the same as spiral CT.