超声容积导航引导经腰椎间孔穿刺的应用解剖  

Applied anatomy for transforaminal puncture using ultrasound volume navigation technique in cadavers

作　　者：刘彦斌[1] 李军[1] 付强[1] 王茵[2] 

机构地区：[1]第二军医大学附属长海医院脊柱外科,上海200433 [2]第二军医大学附属长海医院超声科,上海200433

出　　处：《解剖学杂志》2015年第6期713-713,共5页Chinese Journal of Anatomy

摘　　要：目的:在尸体上应用实时超声图像与CT图像融合的容积导航引导经椎间孔穿刺并评估其准确性并探讨超声容积导航技术引导椎间孔穿刺应用于临床的可行性.方法:在5具尸体上,应用容积导航技术引导双侧椎间孔穿刺,每具均进行双侧L1/2～L4/5椎间孔穿刺,共进行40次穿刺.记录配准误差、超声所能观察到针尖的最后位置距靶点距离(DNT)及总穿刺时间(包括配准及放置穿刺针时间),CT测量穿刺误差(导航到位后经CT验证针尖到目标靶点的距离),以此验证超声引导穿刺的准确性.结果:尸体实验中,配准误差为(2.78±0.87) mm,DNT为(20.24±1.69) mm,穿刺误差为(2.89±1.18) mm,总穿刺时间为22.3mn±4.5 min,其中图像配准时间19.1 min±4.3 min,放置穿刺针时间3.3 min±0.7 min.结论:与传统C臂机导航相比,利用实时超声图像与CT图像融合的容积导航技术可准确引导腰椎经皮后外侧入路椎间孔穿刺,将该技术应用于临床,能明显减少X线辐射量,在经皮内窥镜下腰椎间盘切除术椎间孔穿刺中有着广阔的应用前景.Objective:To evaluate the accuracy of volume navigation technique using fusion of real-time ultrasound(US) with computed tomographic(CT) images for guiding percutaneous posterolateral transforaminal puncture in cadavers and the clinical feasibility of applying volume navigation technique in lumbar transforaminal puncture with full-endoscopic technique through posterolateral approach.Methods:40 navigation-guided transforaminal punctures were performed on both sides at the L1/2-L4/5 level in 5 cadavers.The registration error,total time of puncture(including the time of registration and the time of needle placement),US-observed distance between needle tip and target(DNT),and puncture error were recorded,to verify the accuracy of navigation-guided puncture.Results:In the cadaver experiment,the mean registration error was 2.78 mm;mean DNT 20.24 mm;mean puncture error 2.89 mm;and mean overall time of puncture 22.3 min.Mean time of registration was 19.1 min,mean time of needle placement was 3.3 min.Conclusion:Compared with the conventional C-arm machine guidance,the ultrasound volume navigation can guide the lumbar transforaminal puncture with full-endoscopic technique through posterolateral approach accurately and reduce the amount of X-ray radiation significantly.

关 键 词：超声容积导航 内窥镜 椎间孔 穿刺 微创 解剖学 

分 类 号：R322.7[医药卫生—人体解剖和组织胚胎学]