使用锥形束计算机断层扫描导航进行骨盆骨转移的经皮螺钉固定。
Percutaneous screw fixation of pelvic bone metastases using cone-beam computed tomography navigation.
机构信息
Department of Interventional Radiology and Oncology, Sorbonne Université, Tenon Hospital, AP-HP, 75020 Paris, France; Memorial Sloan Kettering Cancer Center, Interventional Radiology, 10065 New York, NY, USA.
Department of Interventional Radiology and Oncology, Sorbonne Université, Tenon Hospital, AP-HP, 75020 Paris, France.
出版信息
Diagn Interv Imaging. 2022 Jul-Aug;103(7-8):367-374. doi: 10.1016/j.diii.2022.01.002. Epub 2022 Jan 13.
PURPOSE
The purpose of this study was to evaluate the efficacy of cone-beam computed tomography (CBCT) navigation to achieve percutaneous screw fixation (PSF) of pelvic bone metastases (PBM).
MATERIALS AND METHODS
Thirty-five consecutive patients (12 men and 23 women; mean age, 62 ± 11.3 [SD]; range: 39-89 years) treated between 2019 and 2021 were retrospectively included. CBCT navigation software was systematically used. Manual drawing of the entry point (MDEP) was performed when CBCT automatic positioning failed. Influence of metastasis pattern, ablation, body mass index, number of screws, and MDEP on procedure duration (PD) and total Air Kerma (AK) was evaluated. Local pain was assessed before, one and six months after treatment. Variables were compared using Pearson correlation, Student t and Wilcoxon tests.
RESULTS
Seventy-five screws were inserted successfully (mean: 2.1 ± 1.1 [SD]; range: 1-5 per patient). CBCT automatic positioning was obtained for 41 screws (55%, 41/75), whereas 34 (45%, 34/75) required MDEP. Mean procedure duration, fluoroscopy time, kerma air product and AK were 73.3 ± 44.8 (SD) min (range: 19-233 min), 13.1 ± 9.5 (SD) min (range: 1.4-38.6 min), 73.8 ± 66.3 (SD) Gy.cm (range: 11.6-303.7 Gy.cm) and 301.7 ± 242.1 (SD) mGy (range: 49.4-1111.5 mGy), respectively. Procedure duration was not significantly longer in patients with mixed or blastic PBM compared to those with lytic PBM or when performing ablation, and no significant correlations were observed with the number of screws inserted (P = 0.19), MDEP (P = 0.37) and BMI (P = 0.44). No adverse events were reported during the follow-up (median: 6 months; IQR: 6-6.5 months). Thirteen patients died during the follow-up related to cancer progression. Local pain decreased from 35 ± 32 (SD) mm (range: 0-10 mm) to 11 ± 20 (SD) mm (range: 0-80 mm) at one month (P = 0.001); and to 22 ± 23 (SD) mm (range: 0-60 mm) at six months (P = 0.001).
CONCLUSION
CBCT navigation allows to effectively performing PSF of PBM even in the presence of steep angulations.
目的
本研究旨在评估锥形束 CT（CBCT）导航在经皮骨转移瘤（PBM）螺钉固定中的疗效。
材料与方法
回顾性纳入 2019 年至 2021 年期间治疗的 35 例连续患者（12 名男性和 23 名女性；平均年龄 62±11.3[SD]；年龄范围：39-89 岁）。系统使用 CBCT 导航软件。当 CBCT 自动定位失败时，进行手动画入口点（MDEP）。评估转移模式、消融、体重指数、螺钉数量和 MDEP 对手术时间（PD）和总空气比释动能（AK）的影响。在治疗前、治疗后 1 个月和 6 个月评估局部疼痛。使用 Pearson 相关、学生 t 检验和 Wilcoxon 检验比较变量。
结果
成功插入 75 枚螺钉（平均：2.1±1.1[SD]；范围：每个患者 1-5 枚）。41 枚螺钉（55%，41/75）获得 CBCT 自动定位，34 枚（45%，34/75）需要 MDEP。平均手术时间、透视时间、空气比释动能和 AK 分别为 73.3±44.8（SD）min（范围：19-233 min）、13.1±9.5（SD）min（范围：1.4-38.6 min）、73.8±66.3（SD）Gy.cm（范围：11.6-303.7 Gy.cm）和 301.7±242.1（SD）mGy（范围：49.4-1111.5 mGy）。与溶骨性 PBM 患者相比，混合性或成骨性 PBM 患者的手术时间无明显延长，行消融治疗时手术时间也无明显延长，且与插入螺钉的数量（P=0.19）、MDEP（P=0.37）和 BMI（P=0.44）均无显著相关性。在随访期间（中位时间：6 个月；IQR：6-6.5 个月）未报告任何不良事件。13 例患者在随访期间因癌症进展而死亡。治疗后 1 个月（P=0.001）和 6 个月（P=0.001）时，局部疼痛从 35±32（SD）mm（范围：0-10 mm）降至 11±20（SD）mm（范围：0-80 mm），降至 22±23（SD）mm（范围：0-60 mm）。
结论
即使存在陡峭的角度，CBCT 导航也能有效地进行 PBM 的 PSF。
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