Kobayashi Ken, Takizawa Kenji, Koyama Masamichi, Yoshimatsu Misako, Sakaino Shinjiro, Nakajima Yasuo
Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan.
Radiat Med. 2006 Apr;24(3):187-94. doi: 10.1007/s11604-005-1542-0.
The aim of this study was to improve the accuracy of puncture to the median vertebral body using the unilateral transpedicular approach on percutaneous vertebroplasty (PVP). We have developed and evaluated a simple puncture simulation method based on the puncture angle determined by preoperative computed tomography (CT).
Two groups were evaluated. The first (group A) comprised 23 patients (34 vertebral bodies) who had undergone PVP without preoperative puncture simulation before May 2004, and the second group (group B) comprised 24 patients (39 vertebral bodies) who had undergone preoperative puncture simulation and PVP after May 2004. CT in the prone position was performed, and the puncture angle on CT (PAC) via the vertebral arch pedicle targeting the anterior one-third median site of the vertebral body was determined. Puncture was performed by targeting the isocenter established on a fluoroscopic monitor based on the PAC. Determinations were made of the success rate (SR) of the median puncture of the vertebral body, the effect of treatment using the visual analogue score, and the overall procedural time between groups A and B.
The SR was 56% (19/34 vertebral bodies) in group A, and 97% (37/38 vertebral bodies), including only one vertebral body in which it was difficult to perform the unilateral approach on CT images, in group B, with the difference being significant by Student's t-test (P < 0.001). Among patients with available follow-up data, the unipedicular and bipedicular approaches achieved adequate pain relief with mean decreases in pain severity of 5.1 +/- 2.6 and 5.9 +/- 2.8, respectively. No significant differences in the treatment effect between the two groups was observed (P = 0.811). The overall procedure time per puncture was shorten for the simulation group (36.0 min) than for group A (73.1 min), as shown by regression analysis.
The preoperative PAC determination for PVP under fluoroscopy increased the completion rate of PVP by the unilateral transpedicular approach. This method should be accepted from the viewpoint of burden reduction on patients and surgeons.
本研究旨在提高经皮椎体成形术（PVP）中采用单侧椎弓根入路穿刺至椎体正中的准确性。我们基于术前计算机断层扫描（CT）确定的穿刺角度，开发并评估了一种简单的穿刺模拟方法。
对两组患者进行评估。第一组（A组）包括23例患者（34个椎体），这些患者在2004年5月之前接受了PVP且未进行术前穿刺模拟；第二组（B组）包括24例患者（39个椎体），这些患者在2004年5月之后接受了术前穿刺模拟及PVP。患者取俯卧位行CT检查，确定经椎弓根至椎体前中1/3部位的CT上的穿刺角度（PAC）。根据PAC在透视监视器上确定等中心进行穿刺。比较A组和B组椎体正中穿刺成功率（SR）、采用视觉模拟评分法评估的治疗效果以及总的操作时间。
A组的SR为56%（19/34个椎体），B组的SR为97%（37/38个椎体，CT图像上仅1个椎体难以采用单侧入路），两组差异有统计学意义（Student's t检验，P < 0.001）。在有随访数据的患者中，单侧和双侧入路均实现了充分的疼痛缓解，疼痛严重程度平均分别降低5.1±2.6和5.9±2.8。两组治疗效果无显著差异（P = 0.811）。回归分析显示，模拟组每次穿刺的总操作时间（36.0分钟）短于A组（73.1分钟）。
透视下PVP术前确定PAC提高了单侧椎弓根入路PVP的完成率。从减轻患者和外科医生负担的角度来看，该方法值得采用。
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