DSA引导下经胸椎椎弓根外穿刺途径PVP和PKP手术治疗高位胸椎骨折

目的探讨DSA引导下治疗高位胸椎病变的经椎弓根外穿刺途径PVP和PKP的操作要点和注意事项。方法术前进行CT测量,在水平面断层上标出胸椎椎弓根外侧穿刺途径,测量皮肤穿刺点与后正中线的距离;与矢状面的夹角-＂外倾角＂;测量骨性入钉点距离椎弓根中点外侧的长度-＂骨性通道长度＂,骨性入钉点距离椎弓根中点外侧垂线的长度-＂骨性通道前后投影距离＂;在矢状位通过椎弓根的重建图像上,测量椎弓根轴线与椎体水平轴线的夹角-＂矢状位倾角＂,以此为指导,在DSA引导下进行PKP和PVP操作,治疗胸椎骨折15例21个椎体。结果PVP4例6节段,PKP11例15节段,操作顺利,平均手术时间,无穿刺并发症,VAS评分：术前平均为（9.3±0.3）分,术后平均为（4.3±0.4）分,统计学分析,差异有统计学意义（P〈0.05）。结论术前对CT扫描图像进行全面的测量,可以指导DSA引导下高位胸椎椎弓根外侧穿刺的顺利完成。

Extrapedicular Approach of Percutneous Vertbroplasty or Kyphoplasty Guided by DSA in Treatment of Upper and Mid-thoracic Vertebral Compression Fracture

Objective To explore the characteristic of track of percutaneous extrapedicular approach puncture in the upper and mid-thoracic vertebras under DSA guidance.Methods On CT three-dimensional images,the horizontal distances between percutaneous puncturing sites and spinous process,the direction of approach and ＂the osteous track＂were measured.Under the DSA guidance,15 cases with 21 upper and mid-thoracic vertebral fractures were treated with PVP or PKP via the extrapedicular approach puncture.Results 4 cases were performed with PVP,11 cases were treated with PKP.All of the puncturings were successfull.The VAS scales were（9.3±0.3） preoperationly and（4.3±0.4） postoperationly（P0.05）.Conclusion Percutaneous vertebroplasty or kyphoplasty via the extrapedicular track is safe in the treatment of upper and mid-thoracic vertebral compression fracture.＂The osteous track＂should be measured on the CT three dimensional images before the PVP and PKP.