经肋骨入路椎体强化术适应证的影像解剖学观察及临床应用效果

目的:探讨经肋骨入路行椎体强化术的适应证和治疗效果。方法:回顾性研究。纳入无锡市第九人民医院影像科数据库2019年1—12月100例患者的胸椎CT影像资料，其中男女各50例，年龄20~70岁。利用CT影像模拟经肋骨入路沿通道中心轴插入直径4 mm穿刺针，观察穿刺针在横断面和矢状面上可到达椎体内的位置。纳入2018年1月...

Imagine observation of indications and therapeutic effects of vertebral augmentation via rib approach

Objective To investigate the indications and therapeutic effects of vertebral augmentation via rib approach. Methods This was a retrospective study, in which the data of thoracic vertebrae CT scanning of 100 cases were selected from the imaging database of Wuxi the Ninth People's hospital. The position of the puncture needle (with a diameter of 4 mm) that reached the vertebral body through the rib was measured by CT simulation. In our two hospitals from January 2018 to June 2020, 35 thoracic segments of 26 patients (11 males and 15 females in the age range of 41–88 years old), 18 cases of thoracic compression fractures, 5 cases of thoracic hemangioma, and 3 cases of metastatic tumor on whom vertebral augmentation via rib approach was performed were included. The pain (visual analogue scales, VAS), Oswestry disability index (ODI), height of the vertebral body, and complications were observed. Results In the transverse plane, the needle reached the center of the median-sagittal line of the vertebral body only in T_5-10. While in the sagittal plane, the needle did not reach the lower part of the vertebral body. Nine segments were punctured unilaterally and 27 segments were punctured bilaterally. The dosage of bone cement injection was 3.0–8.0 mL. Pain relief was felt by all 26 patients. The postoperative follow-up was from 6 months to 28 months, with an average of 13 months. Before surgery at the 1st week after surgery and at the last follow-up VAS scores of the patients were (8.0 ± 1.6), (2.4 ± O.8), and (1.2 ± O.7); ODIs were 85.1% ± 10.2%, 13.4% ± 5.9%, and 12.4% ± 5.8%; the vertebral anterior margin heights were 52.4% ± 12.4%, 82.2% ± 13.7%, and 80.7% ± 12.0%; and the vertebral posterior margin heights were 58.8% ± 15.5%, 86.3% ± 13.2%, and 84.6% ± 10.7%, respectively. Compared with the preoperative, the VAS and ODI of patients decreased at the 1st week after surgery. At the last follow-up, and the relative heights of anterior and posterior vertebral bodies increased. The VAS scores of the patients at the last follow-up decreased compared with the 1st week after surgery, with statistical significance (all P values < 0.05). Leakage of bone cement in the paravertebral vein, adjacent soft tissue, or intervertebral space was found in seven segments of five cases. Leakage of bone cement into the spinal canal and nerve injury were not observed. Conclusion Vertebral augmentation via rib approach is indicated for T_5-10 segments with the fractures or space-occupying lesions located in the middle and upper parts of the vertebral body. The procedure has the characteristics of simple operation, few complications, and particular suitability for local anesthesia.