单侧穿刺经皮椎体成形术的影像学研究及临床应用

目的 :通过对下胸椎及腰椎相关参数进行测量,明确单侧经皮椎体成形术的外展角及进针点距棘突的距离,指导临床应用。方法:对40例(男17例,女23例)正常成人的T10-L5进行薄层CT扫描,厚度为1 mm,选择通过椎弓根、关节突关节及横突的横断面图像,由CT自带图像处理软件测量经椎弓根穿刺的最大和最小穿刺角度及进针点距棘突的距离,并根据测量结果指导临床应用。结果:椎体穿刺的最佳角度和进针点的数值在T10-L5间总体呈逐渐增大趋势,从T10-T12略有下降,然后逐渐增大,至L5时获得最大值;根据测量结果对60例胸腰椎骨折患者进行单侧穿刺椎体成形术,术后椎体后凸矫正率满意,VAS评分明显下降(P0.05)。结论:术前对穿刺相关数据参数进行测量,可以很好地指导术中操作,降低手术风险,提高穿刺成功率。

Imaging study and applied research of the puncture angle in unilateral percutaneous vertebroplasty

Objective: To clarify the abduction angle and needle insertion point of unilateral percutaneous vertebroplasty by measuring the related parameters of lower thoracic spine and lumbar vertebrae.Methods: Forty normal adults were included in the study,there were 17 males and 23 females. They were scanned by CT with thickness of 1 mm on T₁₀-L₅. The coross-section figures of pedicle of vertebral arch,zygapophysial joints,transverse process were choosed,and the maximal and minimal angle of transpedicular puncture,the puncture distance to posterior midline were measured by the image processing software of CT.Results: The data of pucturing angle and point distance had a increasingly trend from T₁₀ to L₅ in overall,including a slight decrease from T₁₀ to T₁₂,then was gradually increased until L₅,where the maximum was got. According to the measurement,the unilateral percutaneous vertebroplasty were performed,and postoperative Cobb angle of 60 patients were obviously corrected,VAS had significantly decreased (P<0.05).Conclusion: Preoperative measurement of relevant parameters can guide the operation,improve the successful rate of unilateral puncture.