摘要
目的明确胸腰椎经皮穿刺椎体成形术中确定进针终点后单侧穿刺外展角的安全范围。方法收集2011年1月至2012年1月老年骨质疏松性压缩性胸腰椎骨折患者的胸椎、腰椎CT扫描片,随机选择胸椎、腰椎患者各40例(男、女各20例)共520张CT扫描片(胸椎320张、腰椎200张)。采用DICOM Medical ImageViewer Ver 1.01 软件对 CT 片椎体断面相关外展角数据进行测量。首先确定椎体正中线前、中 1/3 交界点为穿刺终点,然后分别测量经椎弓根外缘、内缘至终点的连线与正中线之间的夹角(穿刺最大、最小角度),以及经椎弓根轴线至终点与正中线的夹角(穿刺轴向角)。结果胸椎(T5～T12)最大、最小穿刺角度和轴向角度分别为28.3°～37.4°、17.2°～23.1°和 19.2°～29.9°;腰椎最大、最小穿刺角度和轴向角度分别为 31.9°～44.8°、14.2°～26.5°、和 23.5°～35.4°。男性最大、最小穿刺角度及轴向角度分别为 28.3°～44.5°、14.2°～25.7°和 19.2°～35.4°;女性最大、最小穿刺角度及轴向角度分别为29.3°～44.8°、17.2°～26.5°和23.2°～35.9°。对男性、女性各指标进行比较,差异无统计学意义(P >0.05)。结论对于老年骨质疏松性压缩性胸腰椎骨折患者,单侧经皮穿刺椎体成形术在确定于椎体正中线前、中1/3交界点处为进针终点后,应保持30°左右外展角进针,以确保安全性和最佳成形效果。
Objective To clarify the safety limitation of abduction angles of puncture of unilateral percutaneous vertebroplasty（PVP） for thoracic and lumbar vertebrae when puncture needle end point being determined.Methods CT scan images of thoracic and lumbar vertebrae of elderly patients with osteoporotic vertebral compression fracture（OVCF） from January 2011 to January 2012 were collected,All 520 pictures of CT scan including 320 thoracic vertebral and 200 lumbar vertebral pictures of each were selected randomly,with 40 cases of thoracic fracture and 40 cases of lumbar fracture（half male and half female）.Data of the abductionangles on vertebral body cross-section were measured by DICOM Medical Image Viewer Ver 1.01 software.First step was to determine the end point at anterocentral 1/3 of the vertebral midline as puncture end point.Included angles between midline and line of transpedicular outer wall,inner wall to puncture end point were determined as puncture maximum and minimum angles respectively,and angles of transpedicular axial line to midline as puncture axial angles.Results Maximum and minimum angles as well as axial angles of thoracic puncture angle from T5-T12 were 28.3°-37.4°,17.2°-23.1°and 19.2°-29.9°,and those of lumbar puncture angle were 31.9°-44.8°,14.2°-26.5° and 23.5°-35.4°respectively.Maximum and minimum angles as well as axial angles in male patients were 28.3°-44.5°,14.2°-25.7°and 19.2°-35.4°,and the parameters in female patients were 29.3°-44.8°,17.2°-26.5° and 23.2°-35.9° respectively,the difference between male and female patients had no statistical significance（P 0.05）.Conclusions For OVCF patients,abduction puncture angles of unilateral PVP should be kept about 30° after the puncture end point being determined at anterocentral 1/3 of the vertebral midline,so as to ensure the surgical safety and good therapeutic effects.
出处
《中国骨科临床与基础研究杂志》
2012年第5期350-355,共6页
Chinese Orthopaedic Journal of Clinical and Basic Research
关键词
椎体成形术
胸椎
腰椎
穿刺角度
Vertebroplasty
Thoracic vertebrae
Lumbar vertebrae
Puncture angles
