单侧经横突-椎弓根入路腰椎椎体强化术的解剖学研究

发布时间：2018-01-21 01:46

本文关键词： 腰椎解剖学参数经皮椎体强化术手术入路　出处：《中国修复重建外科杂志》2017年11期 　论文类型：期刊论文

【摘要】：目的测量单侧经横突-椎弓根入路腰椎经皮椎体强化术的相关解剖学参数,探讨该入路行椎体强化术的可行性与安全性。方法随机选取60例患者共300个腰椎椎体,在X线片图像和CT图像上分别模拟单侧经传统椎弓根入路(对照组)和单侧经横突-椎弓根入路(研究组)完成经皮椎体强化术600次。测量并比较同一手术入路L_1~L_5各椎体左右侧及两种手术入路L_1~L_5各椎体X线片图像和CT横断面上穿刺点至椎体中线的距离、穿刺外偏角、穿刺角安全范围和穿刺成功率。结果两组L_1~L_5椎体左右侧穿刺点至中线的距离均逐渐增大,其中对照组L_1、L_2右侧距离显著大于左侧,研究组L_1、L_2、L_5右侧距离显著大于左侧(P0.05);研究组L_1~L_5椎体左侧或右侧穿刺点至中线的距离均显著大于对照组(P0.05)。研究组L_1~L_5右侧最大外偏角、中点外偏角及L_1、L_2、L_4、L_5最小外偏角均显著大于左侧(P0.05)。L_1~L_5左右侧最大外偏角、中点外偏角逐渐增大,最小外偏角变化不明显,但所有外偏角均显著大于对照组(P0.05)。两组L_1~L_5左右侧穿刺角安全范围差异无统计学意义(P0.05);研究组L_5左右侧穿刺角安全范围显著小于对照组(P0.05)。对照组和研究组所有椎体穿刺总成功率差异有统计学意义(χ~2=172.252,P=0.000);其中研究组L_1~L_4穿刺成功率显著高于对照组(P0.05),L_5穿刺成功率两组比较差异无统计学意义(P0.05)。结论单侧经横突-椎弓根入路的穿刺点较传统经椎弓根入路偏外,穿刺外偏角更大,穿刺总成功率更高。单侧经横突-椎弓根入路是一种较传统经椎弓根入路更安全、可靠的穿刺入路。
[Abstract]:Objective to measure the anatomical parameters of unilateral transtransverse process-pedicle approach for percutaneous lumbar vertebra enhancement. To explore the feasibility and safety of this approach, 300 lumbar vertebrae were randomly selected from 60 patients. Unilateral transpedicular approach (control group) and unilateral transtransverse process-pedicle approach (study group) were simulated on X-ray and CT images, respectively. Six hundred times of percutaneous vertebra augmentation were performed. We measured and compared the L1, L1, L5, L1, L5, L1, L5, L1, L5, and L1, L5, the same surgical approach, and the puncture points on the cross section of CT. Distance to the midline of the vertebra. Results the distance between the puncture point and the midline of L1 / L _ 5 vertebra in both groups was gradually increased, and the control group was L1 / L _ 1. The right side distance of L2 was significantly larger than that of left side, and the right side distance of the study group was significantly larger than that of the left side. The distance from left or right puncture point to midline in the study group was significantly larger than that in the control group (P 0.05). The minimum external deflection of L2L / L _ 4L _ S _ 5 is significantly higher than that of P0.05T / L _ 1 / L _ T _ 1 / L _ 1 / L _ 1 / L _ T _ 5. The angle of the outer deviation of the midpoint increases gradually, and the change of the minimum angle is not obvious. However, all the external angles were significantly higher than those of the control group (P 0.05). There was no significant difference in the safety range of the left and right puncture angles between the two groups (P 0.05). The safe range of L5 left and right puncture angle in the study group was significantly smaller than that in the control group (P 0.05). There was significant difference in the total success rate between the control group and the study group (蠂 2 172.252). P0. 000; The success rate of L1 and L4 puncture in the study group was significantly higher than that in the control group (P0.05). There was no significant difference in the success rate of L5 puncture between the two groups (P 0.05). Conclusion the puncture point of unilateral transtransverse process-pedicle approach is higher than that of the traditional transpedicular approach. Unilateral transtransverse procession-pedicle approach is a more safe and reliable approach than traditional transpedicular approach.
【作者单位】：沈阳军区总医院骨科;
【基金】：浙江大学计算机辅助设计与图形学国家重点实验室开放课题(A1718) 中国科学院沈阳自动化所机器人学国家重点实验室开放课题(2014-O12、2017-O01) 辽宁省博士科研启动基金课题(201601389) 华中科技大学材料与模具技术国家重点实验室开放课题(P2018-011)~~
【分类号】：R322.7;R687.3
【正文快照】： 2001年,Lieberman等[1]报道应用经皮球囊椎体此后在临床上开展该技术提供解剖学参考。报告后凸成形术(percutaneous kyphoplasty,PKP)能有如下。效缓解椎体压缩性骨折患者的疼痛,改善后凸畸1材料与方法形,此后该技术在临床上得以普遍开展。经典的椎体强化术是双侧经椎弓根入路

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