经皮椎体成形术后骨水泥渗漏的影像学评估策略分析

 目的 分析经皮椎体成形术(percutaneous vertebroplasty, PVP)骨水泥渗漏的X线及CT表现,探讨术后的影像学评估策略。方法 选取2016-01至2019-12在解放军总医院第六医学中心行PVP的80例患者共102椎,术后均行患椎X线平片检查,其中36例同时行患椎CT三维重建,13例行胸部CT三维重建,分析骨水泥渗漏的表现,对比X线和CT的检出率。结果 CT发现36例47椎出现骨水泥渗漏,共77个部位(30个椎旁静脉渗漏、9个椎管渗漏、15个椎旁软组织渗漏、17个椎间盘渗漏、6个穿刺通道渗漏),渗漏率为46.1%,其中X线发现骨水泥渗漏60个部位(78.0%)。椎旁静脉渗漏(39.0%)最为常见,包括下腔静脉骨水泥栓塞3个(3.9%),奇静脉骨水泥栓塞2个(2.6%),胸部CT发现肺动脉骨水泥栓塞4个(5.1%)。结论 X线平片和CT三维重建联合应用提高了PVP术后骨水泥渗漏的检出率,可以更准确地评估骨水泥渗漏的局部和全身状况。

Strategies for imaging evaluation of cement leakages after percutaneous vertebroplasty

Objective To assess retrospectively the images of cement leakages and to evaluate X-ray and CT for the complications of percutaneous vertebroplasty (PVP). Methods Eighty patients underwent PVP and a total of 102 vertebrae were treated between January 2016 and December 2019. X-ray examinations were performed in all the patients after PVP while CT examinations were performed in 36 patients.The locations and features of cement leakages of each vertebra were recorded and analyzed. Results Seventy-seven locations of cement leakages were detected in a total of 47 vertebrae in 36 patients by CT, including 30 paravertebral venous leakages, 9 spinal canal leakages,15 paravertebral soft tissue leakages, 17 intrevertebral discs leakages,and 6 needle tract leakages.The leakage rate was 46.1%.Sixty locations of cement leakages were detected by X-ray (78.0%).The dominating cement leakage was venous leakages(39.0%), as inferior vena cava emblism was detected in 3 patients(3.9%), azygos embolism in 2 patients(2.6%), and pulmonary embolism in 4 patiends(5.1%). Conclusions CT three-dimensional reconstruction combined with X-ray is an effective approach to the evaluation of cement leakages of PVP. Vertebral CT and thoracic CT can facilitate early detection of such venous leakages as inferior vena cava embolism, azygos embolism and pulmonary embolism. Moreover, vertebral CT can be conducive to early detection of spinal damages in case of spinal canal leakage.