胸腰段行经皮椎体后凸成形术经单侧穿刺入路的CT影像学分析及临床应用

发布时间：2018-06-28 16:02

本文选题：经皮椎体后凸成形术 + 胸腰段　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:通过对胸腰段(T10-L2)各节段椎体CT影像学上的相关测量,研究出胸腰段各节段椎体行经皮椎体后凸成形术(percutaneous kyphopoplasty,PKP)经单侧穿刺入路的最佳穿刺外展角度及皮肤穿刺点距后正中线的距离,为临床骨科医师行单侧PKP治疗患者时提供参考。方法:随机选取2014年10月至2016年5月来我院诊疗的100例非骨折胸、腰椎患者,男性50例,女性50例;在我科PACS系统中调取患者的胸、腰椎CT,查看CT影像学检查结果并进行回顾性分析。针对胸腰段各节段椎体的CT图像,我们选取CT轴位像上两侧椎弓根最宽的那一层,在该层上做椎体前后正中线段,并在该线段上选取前1/3的那一点,过该点做垂线,该垂线与椎体两侧各有一交点,任选一点和正中线段于椎体前侧的交点及正中线段的前1/3点构成一个三角形,即为穿刺针所达理想区域,做此三角形的重心,为理想区域的代表点,以此为单侧穿刺时穿刺针所达的目标点进行模拟穿刺,穿刺轨迹距椎弓根内侧壁距离为套管的半径(2mm),此时穿刺轨迹与矢状面的夹角即为最佳外展角,测量T1O至L2各节段椎体经单侧穿刺入路行PKP手术时穿刺针的最佳外展角度及皮肤穿刺点距后正中线的距离。统计100例患者的性别、年龄、身高、体重,并探究在胸腰段各节段椎体行PKP经单侧穿刺入路的最佳外展角度及皮肤穿刺点距后正中线的距离与性别、年龄、身高、体重是否有相关性。结果:胸腰段各节段椎体经单侧穿刺入路行PKP手术的最佳外展角度及皮肤穿刺点距后正中线距离的测量结果有很大差异(P0.05)。在T10椎体PKP单侧穿刺入路的最佳外展角度平均值为(31.48±0.66)°;在T11椎体外展角度平均值为(33.19±0.70)°;在T12椎体外展角度平均值为(34.83±0.52)°;在L1椎体外展角度平均值为(36.81±0.67)°;在L2椎体外展角度平均值为(38.22±0.71)°。PKP经单侧入路在最佳穿刺外展角度的情况下皮肤穿刺点距后正中线的距离,在T10椎体平均距离为(43.42±2.07)mm;在T11椎体平均距离为(49.06±2.88)mm;在T12椎体平均距离为(53.70±1.72)mm;在L1椎体平均距离为(58.63±1.88)mm;在L2椎体平均距离为(63.33±2.57)mm。结论:PKP经单侧穿刺入路的最佳外展角度及皮肤穿刺点距后正中线的距离与胸腰段各节段椎体之间有很大相关性。从T10至L2椎体,PKP经单侧穿刺入路的外展角度及皮肤穿刺点距后正中线的距离越来越大。在T11、L1节段,相同节段椎体女性外展角度平均比男性大约多出1°;在T10、T12、L2节段,男女差异不显著。在T10至L2节段,相同节段椎体皮肤穿刺点距后正中线距离男性平均比女性大约多出3.6mm。而外展角及皮肤穿刺点距后正中线的距离与病人年龄、身高、体重之间没有明显相关性。本研究的测量结果可为临床骨科医师在利用PKP单侧穿刺入路治疗老年骨质疏松性椎体压缩骨折时提供参考。
[Abstract]:Objective: to measure the CT correlation of thoracic and lumbar vertebrae (T10-L2). To study the optimal puncture outreaching angle and the distance between the skin puncture point and the posterior median line of percutaneous kyphopoplastyplasty (percutaneous kyphopoplasty-PKP) in thoracolumbar vertebrae, which provides reference for clinical orthopedic surgeon to treat patients with unilateral PKP. Methods: from October 2014 to May 2016, 100 cases of non-fracture chest, including 50 males and 50 females, were selected from our hospital from October 2014 to May 2016. Ct findings of lumbar spine were reviewed and analyzed retrospectively. For the CT images of the thoracolumbar vertebrae, we selected the widest layer of the pedicle on both sides of the spine, made the anterior and posterior midline of the vertebrae in this layer, and chose the first third of the point on the segment to be a perpendicular line. The perpendicular line has an intersection with each side of the vertebrae, and any point and median line at the intersection of the front side of the vertebra and the first third of the midline constitute a triangle, that is, the ideal region reached by the puncture needle, making the center of gravity of the triangle. As the representative point of ideal region, the target point reached by the puncture needle during unilateral puncture is simulated puncture. The distance from the puncture track to the inner wall of the pedicle is the radius of the casing (2mm), and the angle between the puncture trajectory and the sagittal plane is the best outreaching angle. The optimal outreaching angle of puncture needle and the distance from the point of skin puncture to the posterior median line were measured during the operation of PKP in each segment of T _ (10) to L _ (2) vertebrae. The sex, age, height and weight of 100 patients were counted, and the best abduction angle of PKP through unilateral puncture approach and the distance between skin puncture point and posterior median line, gender, age, height, were investigated in all vertebrae of thoracolumbar segment. Whether weight is relevant. Results: there were significant differences in the measurement of the optimal abduction angle and the distance between the skin puncture points and the posterior median line of the thoracolumbar vertebrae through unilateral puncture approach (P0.05). The average optimal abduction angle of PKP in T10 vertebral body was (31.48 卤0.66) 掳, that in T11 was (33.19 卤0.70) 掳, that in T12 was (34.83 卤0.52) 掳, that in L1 was (36.81 卤0.67) 掳, that in L2 was (36.81 卤0.67) 掳, that in T12 was (34.83 卤0.52) 掳, in that of vertebral body was (36.81 卤0.67) 掳, that in T11 was (33.19 卤0.70) 掳, that in T12 was (34.83 卤0.52) 掳. The average value was (38.22 卤0.71) 掳. The distance between the skin puncture point and the posterior median line under the condition of optimal puncture outreaching angle through the unilateral approach. The mean distance in T10, T11, T12, L1 and L2 were (43.42 卤2.07) mm, (49.06 卤2.88) mm, (53.70 卤1.72) mm, (58.63 卤1.88) mm and (63.33 卤2.57) mm, respectively. Conclusion the optimal outreaching angle and the distance between the skin puncture point and the posterior median line are closely related to the thoracolumbar vertebrae. From T10 to L2 vertebrae PKP through unilateral puncture approach of the abduction angle and skin puncture point from the posterior median line distance is increasing. In the T11L 1 segment, the female abduction angle of the same segment was about 1 掳higher than that of the male, but there was no significant difference between the male and the female at the T10 T 12 L 2 segment. In the T10 to L2 segments, the average distance from the posterior median line to the skin puncture point in the same vertebrae is about 3.6 mm. longer in males than in females. There was no significant correlation between the outreaching angle and the distance between the skin puncture point and the posterior median line and the patient's age, height and weight. The results of this study may provide a reference for clinical orthopedic physicians in the treatment of senile osteoporotic vertebral compression fractures with PKP unilateral puncture approach.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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