Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
Division of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
Diagn Interv Radiol. 2019 Sep;25(5):353-359. doi: 10.5152/dir.2019.18362.
Percutaneous cementoplasty is a minimally invasive treatment modality for painful osteoporotic and pathologic sacral and supra-acetabular iliac fractures. This study compares the use of low-dose CT guidance with CT/CT fluoroscopy in sacral and supra-acetabular cementoplasty.
A retrospective review of patients who had undergone sacral or supra-acetabular cementoplasty was performed with patients grouped by use of CT/CT fluoroscopy or low-dose CT guidance during the procedure. Parameters evaluated included type of fracture, laterality of lesions, pain scores, pain medication use, imaging parameters, procedure time, dose-length product, effective dose, cement volume, and complications.
There were 17 patients identified who underwent cementoplasty utilizing dual CT/CT fluoroscopy, while 13 patients had their procedures performed with low-dose CT. There was a statistically significant decrease in radiation dose in the low-dose CT group (1481 mGy•cm) compared with the CT/CT fluoroscopy group (2809 mGy•cm) (P = 0.013). There was a significant decrease in procedure time with low-dose CT for bilateral lesions (P = 0.016). There was no significant difference between groups in complication rate (P = 0.999). Clinically nonsignificant cement extravasation occurred in two patients (10%) in the CT/CT fluoroscopy group and in one patient (8%) in the low-dose CT group (P = 0.999). There was a significant decrease in pain scores compared with baseline on the visual analogue scale in both groups at 1 week (low-dose CT P = 0.002, CT/CT fluoroscopy P = 0.008) and 1 month postprocedure (low-dose CT P = 0.014, CT/CT fluoroscopy P = 0.004), but no difference between groups at 1 day (P = 0.196), 1 week (P = 0.368), or 1 month (P = 0.514).
Sacral and supra-acetabular cementoplasties can be performed safely and precisely using low-dose multiple-acquisition CT guidance while providing significant radiation dose reduction with no difference in extravasation rates, postprocedural pain reduction, and complications compared with CT/CT fluoroscopy.
经皮骨水泥成形术是一种治疗疼痛性骨质疏松性和病理性骶骨和髋臼上髂骨骨折的微创治疗方法。本研究比较了低剂量 CT 引导与 CT/CT 透视在骶骨和髋臼上骨水泥成形术中的应用。
对接受骶骨或髋臼上骨水泥成形术的患者进行回顾性分析，根据术中使用 CT/CT 透视或低剂量 CT 引导将患者分为两组。评估的参数包括骨折类型、病变的侧别、疼痛评分、止痛药物使用、影像学参数、手术时间、剂量长度乘积、有效剂量、骨水泥量和并发症。
共确定了 17 例采用双 CT/CT 透视行骨水泥成形术的患者，13 例采用低剂量 CT 行骨水泥成形术。低剂量 CT 组的辐射剂量明显低于 CT/CT 透视组（1481 mGy·cm 比 2809 mGy·cm，P = 0.013）。低剂量 CT 双侧病变的手术时间明显缩短（P = 0.016）。两组并发症发生率无显著差异（P = 0.999）。CT/CT 透视组有 2 例（10%）和低剂量 CT 组有 1 例（8%）患者出现临床意义不显著的骨水泥外渗（P = 0.999）。两组患者在视觉模拟评分上的疼痛评分均较基线显著降低，1 周时（低剂量 CT 组 P = 0.002，CT/CT 透视组 P = 0.008）和 1 个月时（低剂量 CT 组 P = 0.014，CT/CT 透视组 P = 0.004）。但两组在 1 天（P = 0.196）、1 周（P = 0.368）和 1 个月（P = 0.514）时差异无统计学意义。
骶骨和髋臼上骨水泥成形术可安全、精确地采用低剂量多采集 CT 引导进行，与 CT/CT 透视相比，可显著降低辐射剂量，骨水泥外渗率、术后疼痛减轻率和并发症发生率无差异。
