C型臂X线机引导下经皮双侧骶髂拉力螺钉固定治疗骶骨H形骨折

目的探讨骶骨H形骨折可行的治疗方法。方法运用C型臂X线机引导下经皮双侧骶髂拉力螺钉固定治疗骶骨H形骨折15例。结果15例患者均获随访，随访时间7—34个月，骨折临床愈合时间3～5个月，术后均未留下明显行走障碍，下蹲等活动接近正常。结论在C型臂X线机精确引导下，经皮双侧骶髂拉力螺钉固定技术能有效地固定骶骨H形骨折中的垂直骨折，纠正骨盆垂直方向移位，操作简洁安全，疗效可靠。     

计算机辅助带锁髓内钉固定胫骨骨折全程规划手术系统的实验研究

目的评价计算机辅助带锁髓内钉固定胫骨骨折全程手术规划系统的有效性及临床可行性。方法在分析系统结构和操作流程的基础上,利用塑料胫骨模型(9根)和尸体胫骨(12具下肢肢体)进行基于C型臂透视图像的术中骨折肢体图像拼接、骨折闭合复位及髓内钉置入仿真测量实验；利用胫骨模型及尸体胫骨进行图像拼接精度分析,以验证图像拼接与规划模块的正确性。利用尸体胫骨进行计算机辅助骨折闭合复位试验,分析骨折复位机构模块的操作可行性。结果图像拼接模块只需术中采集7～10张有效的C型臂图像即可拼接出下肢长骨的全景图像,为采集图像所需的术中透视时间为(19．75±0．61)s；计算机进行X线透视图像采集和拼接总时间为(4．17±0．86)min；塑料模型拼接精度达(1．26±0．76)mm。结论该系统实现了基于C型臂拼接图像的计算机辅助胫骨骨折髓内钉内固定全程手术规划,术中可完成骨折复位图像分析、手术规划、虚拟仿真,髓内钉型号选择以及骨折复位等关键操作,为计算机辅助骨科手术系统治疗长骨骨折搭建了精确、安全、稳定的软硬件技术平台。     

Clinico-Radio-Histopathological Correlation by C-Arm Image-Guided Biopsy in Spinal Tuberculosis

Background/Purpose of the StudyC-arm-guided biopsy is a safe and effective technique for evaluating TB spine and is useful in planning therapy. The purpose of this study was to find a correlation between clinically and radiologically suspected TB spine and C-arm image-guided biopsy-proven cases and to study the complications encountered.MethodsAfter evaluating the clinical, laboratory, X-ray and MRI findings, 92 patients with provisionally diagnosed tubercular spine were subjected to C-arm image-guided biopsy.ResultsAmong our 92 cases, histopathology was positive in 55 cases (59.78%). Out of these 55 histologically positive cases, CBNAAT was positive in 42 cases and negative in the rest 13 cases. Overall, among the 92 cases, CBNAAT was positive in 51(55.43%) of cases, and out of these, histopathology turned out to be positive in 42 of cases. Out of 41 cases with negative CBNAAT, histopathology was suggestive of tuberculosis in 13. The strength of agreement between CBNAAT and histopathology was statistically significant (p < 0.0001; kappa = 0.511). No complication such as bleeding, nerve/cord injury, infection, injury to aorta or pneumothorax was encountered during and after the C-arm biopsy in any case.ConclusionC-arm image-guided biopsy is reasonably accurate and should be used as a tool for diagnosis of TB spine. We recommend histopathological examination as a key component for the diagnosis of TB spine, as it is precise and consumes relatively shorter time. CBNAAT is more rapid but is not a substitute for histopathology for spine TB diagnosis.     

半月神经节射频热凝治疗难治性三叉神经痛

目的探讨半月神经节射频热凝治疗难治性三叉神经痛效果和安全性。方法对三叉神经第Ⅱ支合并第Ⅰ、Ⅲ支或Ⅰ、Ⅱ、Ⅲ支并存疼痛者应用改良的前入路卵圆孔穿刺法行射频热凝毁损术。应用C型臂定位下行卵圆孔穿刺。射频温度控制在75-90℃。结果优良46例，良好1例，总有效率为100％。无严重并发症，随访42例3～18个月，无复发患者。结论在C型臂引导下射频热凝半月神经节毁损术治疗难治性三叉神经痛疗效可靠、定位准确，时患者更安全。     

C型臂引导下关节腔冲洗联合臭氧注射治疗膝关节骨性关节炎疗效观察

目的比较在C型臂引导下单纯膝关节腔冲洗和关节腔冲洗联合臭氧注射治疗膝关节骨性关节炎的临床疗效。方法137例单侧膝关节骨性关节炎患者，完全随机分为单纯关节腔冲洗组（67例）及关节腔冲洗联合臭氧注射组（70例）。单纯关节腔冲洗组每周大量生理盐水＋庆大霉素冲洗1次，关节腔冲洗联合臭氧组每周大量生理盐水＋庆大霉素冲洗加臭氧注射1次，2组连续3次为1个疗程。结果1个疗程后，单纯关节腔冲洗组患者：疗效优27例，良23例，可14例，差3例，优良率为74．6％（50／67）；关节腔冲洗联合臭氧组患者：疗效优35例，良25例，可9例，差1例，优良率为85．7％（60／70），2组比较差异有统计学意义（P〈0．05）。单纯关节腔冲洗组：术后1、2、3个月优良率分别为71．6％（48／67）、68．7％（46／67）、61．2％（41／67）；关节腔冲洗联合臭氧注射组术后1、2、3个月优良率分别为84．2％（59／70）、81．4％（57／70）、80．0％（56／70）；2组各时段比较差异均有统计学意义（均P〈0．05）。2组患者在术中及术后均未见明显不良反应。结论单纯关节腔冲洗和关节腔冲洗联合臭氧注射均能有效治疗膝关节骨性关节炎，但关节腔冲洗联合臭氧注射相对于单纯关节腔冲洗治疗膝关节骨性关节炎，中远期疗效佳，值得临床推广。     

C臂CT引导经皮乙醇消融术在巨块型肝癌经肝动脉化疗栓塞后的近期疗效

目的 评价C臂CT引导经皮无水乙醇消融术(PEI)在巨块型肝癌经肝动脉化疗栓塞术(TACE)后的可行性及近期疗效.方法 回顾分析巨块型肝癌患者95例,其中40例行单纯TACE治疗(对照组),55例行TACE联合PEI治疗(联合组).对照组1个月后重复TACE治疗1次.联合组TACE1周后行PEI.术前经C臂CT扫描评估碘油沉积情况,定位穿刺路径及注入部位.2周后对碘油沉积缺损部分追加PEI.3个月后两组复查CT,对碘油沉积分布情况进行统计学分析.结果 联合组初次PEI术后显示碘油沉积为Ⅰ型、Ⅱ型、Ⅲ型及Ⅳ型病灶分别为41.8％ (23/55)、49.1％(27/55)、7.3％ (4/55)和1.8％(1/55);2周后分别为25.4％ (14/55)、50.9％(28/55)、16.4％(9/55)和7.3％(4/55).再次对除Ⅰ型病灶外的41例患者行PEI.3个月后复查CT,对照组碘油沉积Ⅰ型、Ⅱ型、Ⅲ型及Ⅳ型病灶分别为7.5％ (3/40)、30％(12/40)、42.5％(17/40)、20％(8/40);联合组碘油沉积Ⅰ型、Ⅱ型、Ⅲ型及Ⅳ型病灶分别为30.9％(17/55)、40％ (22/55)、23.6％(13/55)、5.5％(3/55).两组差异有统计学意义.结论 C臂CT成像技术在TACE术后联合PEI治疗巨块型肝癌的指导和评估中具有重要价值,保证了手术的安全性、准确性和有效性.     

Depression of the Thoracolumbar Posterior Vertebral Body on the Estimation of Cement Leakage in Vertebroplasty and Kyphoplasty Operations

Background:

The cross-section of thoracolumbar vertebral body is kidney-shaped with depressed posterior boundary. The anterior wall of the vertebral canal is separated from the posterior wall of the vertebral body on the lateral X-ray image. This study was designed to determine the sagittal distance between the anterior border of the vertebral canal and the posterior border of the vertebral body (DBCV) and to analyze the potential role of DBCV in the estimation of cement leakage during percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP).

Methods:

We retrospectively recruited 233 patients who had osteoporotic vertebral compression fractures and were treated with PVP or PKP. Computed tomography images of T11–L2 normal vertebrae were measured to obtain DBCV. The distance from cement to the posterior wall of the vertebral body (DCPW) of thoracolumbar vertebrae was measured from C-arm images. The selected vertebrae were divided into two groups according to DCPW, with the fracture levels, fracture grades and leakage rates of the two groups compared. A relative operating characteristic (ROC) curve was applied to determine whether the DCPW difference can be used to estimate the degree of cement leakage. The data were processed by statistical software SPSS version 21.0 using independent sample t-test and Chi-square tests.

Results:

The maximum DBCV was 6.40 mm and the average DBCV was 3.74 ± 0.95 mm. DBCV appeared to be longer in males than in females, but the difference was not statistically significant. The average DCPW of type-B leakage vertebrae (2.59 ± 1.20 mm) was shorter than that of other vertebrae (7.83 ± 2.38 mm, P < 0.001). The leakage rate of group DCPW ≤6.40 mm was lower than that of group DCPW >6.40 mm for type-C and type-S, but much higher for type-B. ROC curve revealed that DCPW only has a predictive value for type-B leakage (area under the curve: 0.98, 95% confidence interval: 0.95–0.99, P < 0.001), and when the cut-off value was 4.05 mm, the diagnostic sensitivity and the specificity were 94.87% and 93.02%, respectively.

Conclusions:

Depression of the thoracolumbar posterior vertebral body may be informative for the estimation of cement location on C-arm images. To reduce type-B leakage, DCPW should be made longer than DBCV on C-arm images for safety during PVP or PKP.     

大型C臂机实时引导下经超细支气管镜肺大疱减容术有效性及其影响因素的初探

目的 初步探讨大型C臂机实时引导下经超细支气管镜肺大疱减容术的有效性及其影响因素.方法 6例肺大疱患者均在大型C臂机实时引导下经超细支气管镜工作通道先后通过微导管向目标细支气管注入利多卡因、自身血、纤维蛋白原、凝血酶.通过患者客观症状、肺功能FEV1、胸部HRCT、血气分析、6分钟步行距离等指标评价术式的有效性及其影响因素.结果 6例患者中,术后完全有效2例,明显有效1例,基本有效2例,完全无效1例(有效率83.3％).有效性影响因素可能包括肺大疱周围肺组织对所注入的减容药物反应程度、H RCT扫描肺大疱大小时呼吸动度、肺大疱周围组织内源性弹性回缩作用力大小及其各个作用力的方向、患者特异质等.结论 应用大型C臂机实时引导下经超细支气管镜肺大疱减容术,可以避免手术治疗并发症的发生,缩短住院时间,改善肺功能,提高患者生活状态,值得进一步推广.     

Comparison of Radiation Exposure in Lumbar Pedicle Screw Placement With Fluoroscopy Vs Computer-Assisted Image Guidance With Intraoperative Three-Dimensional Imaging

Background/objective: Little is known about the long-term effects of chronic exposure to ionizingradiation. Studies have shown that spine surgeons may be exposed to significantly more radiation than thatobserved in surgery on the appendicular skeleton. Computer-assisted image guidance systems have beenshown in preliminary studies to enable accurate instrumentation of the spine. Computer-assisted image guidance systems may havesignificant application to the surgical management of spinal trauma and deformity. The objective of this study was to compare C-arm fluoroscopy and computer-assisted imageguidance in terms of radiation exposure to the operative surgeon when placing pedicle screw-rod constructsin cadaver specimens.

Methods: Twelve single-level (2 contiguous vertebral bodies) lumbar pedicle screw-rod constructs (48screws) in 4 fresh cadavers were placed using standard C-arm fluoroscopy and computer-assisted imageguidance (Stealth Station with lso-C^3D ).Pedicle screw-rod constructs were placed at L1-L2, L3-L4, and L5-S1 in 4 fresh cadaver specimens. Imaging was alternated between C-arm fluoroscopy and computer-assistedimage guidance with Stealth Station lso-C^3D. Radiation exposure was measured using ringand badge dosimeters to monitor the thyroid, torso, and index finger. Postprocedure CT scans were obtained to judge accuracy of screw placement.

Results: Mean radiation exposure to the torso was 4.33 ± 2.66 mRemfor procedures performed with standard fluoroscopy and 0.33 ± 0.82 mRem for procedures performed with computer-assisted image guidance. This difference was statistically significant (P = 0.012). Radiation exposure to the index finger and thyroid was negligible for all procedures. The accuracy of screw placement was similar for both techniques.

Conclusions: Computer-assisted image guidance systems allow for the safe and accurate placement ofpedicle screw-rod constructs with a significant reduction in exposure to ionizing radiation to the torso of theoperating surgeon.     

C形臂CT在急性缺血性脑血管病介入治疗中的应用

目的 探讨C形臂CT技术在急性缺血性脑血管病介入治疗中的应用价值.方法 C形臂CT成像技术应用于152例急性缺血性脑血管病患者血管内介入治疗前后图像获取和处理,静脉注射对比剂经VasoCT获取类似CTA的脑血管图像,评估脑血管再通后脑出血或梗死风险.结果 C形臂CT能够在短时间内快速诊断血管缺血病变;152例血管内接触溶栓治疗后发现脑血管再通高灌注引发脑出血17例(前循环出血11例,后循环出血6例),经积极抢救治疗12例痊愈;可清晰显示颅内血管植入支架信息.结论 C臂CT应用于急性缺血性脑血管病介入治疗,有利于及时快速诊断脑缺血病变,迅速发现脑出血等严重并发症,及时有效抢救患者.