三维重建技术量化评估骨水泥分布模式预测经皮椎体成形术后短期疗效

关键词：胸椎  腰椎  骨折，压缩性  骨质疏松  椎体成形术  体层摄影术，螺旋计算机

Keywords:Thoracic vertebrae  Lumbar vertebrae  Fractures,compression  Osteoporosis  Vertebroplasty  Tomography,spiral computed

摘要：

      目的 探讨基于三维重建技术量化评估的骨水泥分布均匀程度对骨质疏松性椎体压缩性骨折（OVCF）患者经皮椎体成形术（PVP）后短期疼痛缓解的影响。方法 2021年1月—2024年1月，采用PVP治疗OVCF患者52例。采用Mimics软件构建椎体三维感兴趣区域（VOI），计算骨水泥三维分布均匀度指数（3D-DUI），将患者分为弥漫组（30例，3D-DUI≥70%）和非弥漫组（22例，3D-DUI < 70%）。以术后3个月视觉模拟量表（VAS）评分改善情况为主要结局，采用单因素和多因素logistic回归法分析基于三维重建技术量化评估的骨水泥分布模式的预后预测能力。结果 骨水泥3D-DUI与VAS评分下降幅度呈显著正相关（r=0.61，P<0.01）。弥漫组术后3个月VAS评分下降幅度、ODI改善率显著优于非弥漫组，差异均有统计学意义（P<0.05）。弥漫组骨密度（BMD）T值≤-3.0患者的疼痛缓解率为88.2%（15/17），非弥漫组BMD T值≤-3.0患者的疼痛缓解率为58.3%（7/12），差异有统计学意义（P<0.05）。弥漫组腰椎骨折患者的疼痛缓解率为90.9%（20/22），非弥漫组腰椎骨折患者的疼痛缓解率为72.7%（8/11），差异有统计学意义（P<0.05）。单因素logistic回归分析显示骨水泥3D-DUI、骨水泥分布模式与疼痛缓解相关；多因素logistic回归分析显示骨水泥3D-DUI为疼痛缓解的独立预测因素。结论 三维重建技术量化评估骨水泥分布模式可有效预测PVP术后疼痛缓解程度。相比骨水泥体积，骨水泥分布质量对严重骨质疏松患者术后疼痛缓解情况影响更大。该量化评价体系证实了骨水泥弥漫型分布的生物力学优势，有助于指导术中决策，实现从“经验填充”到“精准重建”的转变。

Abstract:

      Objective To explore the effect of quantitative evaluation of bone cement distribution uniformity based on three-dimensional reconstruction technology on short-term pain relief in patients with osteoporotic vertebral compression fractures（OVCF） after percutaneous vertebroplasty（PVP）. Methods From January 2021 to January 2024，52 OVCF patients were treated with PVP. Mimics software was used to construct a three-dimensional volume of interest（VOI） of the vertebral body，and the three-dimensional distribution uniformity index（3D-DUI） of bone cement was calculated. The patients were divided into diffuse group（30 cases，3D-DUI≥70%） and non-diffuse group（22 cases，3D-DUI < 70%）. The main outcome was the improvement of visual analog scale（VAS） scores at postoperative 3 months. Univariate and multivariate logistic regression methods were used to evaluate the prognostic ability of bone cement distribution patterns based on three-dimensional reconstruction technology. Results The 3D-DUI of bone cement showed a significant positive correlation with the decrease in VAS score（r=0.61，P<0.01）. The decrease in VAS score and improvement rate of ODI in the diffuse group was significantly better than those in the non-diffuse group，and the differences were statistically significant（P<0.05）. The pain relief rate of patients with bone mineral density（BMD） T value≤-3.0 in the diffuse group was 88.2%（15/17），while in the non-diffuse group was 58.3%（7/12），and the difference was statistically significant（P<0.05）. The pain relief rate of lumbar fractures patients in the diffuse group was 90.9%（20/22），while in the non-diffuse group was 72.7%（8/11），and the difference was statistically significant（P<0.05）. Univariate logistic regression analysis showed that bone cement 3D-DUI and bone cement distribution pattern were correlated with pain relief；multivariable logistic regression analysis identified bone cement 3D-DUI as an independent predictor of pain relief.Conclusions The quantitative evaluation of bone cement distribution uniformity based on three-dimensional reconstruction technology can effectively predict the intensity of pain relief after PVP. Compared to the volume of bone cement，the quality of cement distribution has a greater impact on postoperative pain relief in patients with severe osteoporosis. This quantitative evaluation system confirms the biomechanical advantages of diffuse distribution of bone cement，which helps guide intraoperative decision-making and achieve the transition from “experience filling” to “precise reconstruction”.