经皮椎体成形术中斜面针应用效果观察  

Effect of Bevel Needle in Percutaneous Vertebroplasty

作　　者：袁涛[1] 孙洪瀑[1] 杨祚璋[1] 陈彦锦 杨义豪[1] 

机构地区：[1]昆明医科大学第三附属医院骨科,云南昆明650118

出　　处：《昆明医科大学学报》2015年第2期110-114,共5页Journal of Kunming Medical University

摘　　要：目的探讨斜面穿刺针和菱形穿刺针在经皮椎体成形手术中的应用方法和优势.方法解离成人25-40岁尸体腰椎1-5椎节（L1-5）,共计10×5节,完成各椎节骨含量检测,符合骨含量减少或轻度骨质疏松标准.分别应用斜面穿刺针和菱形穿刺针完成在尸椎上经皮椎体成形术手术模拟操作.手术后行椎体正侧位拍片,使用简易的学生用角度尺和直尺测量穿刺针道偏转数据;观察CT断层扫描下骨水泥在椎体内的分布特点.针道偏转计量数据应用统计软件完成统计分析.结果斜面穿刺针在椎体骨质内发生背向斜面的偏转,偏转角度为（1.83±0.2）°至（3.30±0.3）°.菱形穿刺针在椎体内未发生针道偏转.骨密度值与修正后偏转角度经Pearson相关分析结果显示：2者存在负相关关系,r=-0.991,P=0.001.CT断层扫描显示：自斜面穿刺针之斜面溢出的骨水泥团分布呈现为偏向分布的类椭圆体,随着针体旋转调整,可控制骨水泥注射方向和分布区域;骨水泥自菱形穿刺针顶端溢出后,直接冲向针尖远端,成为类球形体,旋转针体后,不能调整骨水泥注射方向和分布区域.结论实验观察表明,应用斜面穿刺针具实施经皮椎体成形手术,可以在进针和注射过程中充分发挥其所具有天然的设计优势,获得精确的进针路径控制和骨水泥在靶区内的填充控制效果.Objective To discuss the application and advantage of two kinds of needling instrument, the diamond needle and the bevel needle, in percutaneous vertebroplasty（PVP）. Methods We dissociated spinal column of 10 adult corpses and get lumbar vertebraes 1-5（L1-5） 10＊5 sections. After examining each section＇s Bone Mineral Content, we finished percutaneous vertebroplasty, using diamond needle and bevel needle. The different puncture path and the distribution of bone cement were observed. The needle deflection data of puncture path were measured using straightedge and angle ruler on vertebral radiographs. The distribution of bone cement in vertebral was observed on CT scans. Statistical analysis was performed on the deflection measurement data. Results Bevel needle occurred deflection back to slope in the vertebral bone by（1.83±0.2） °-（3.30±0.3） °angle（x±s）. Diamond needle did not occur deflection in the vertebral. CT scan display：the cement biased distribution to the slope of the bevel needle and can be distributed as class ellipsoid by rotating needle. Bone cement from the top of the diamond needle overflows directly toward the apex,becoming a class spheroids and can not be adjustesd the direction and distribution area by rotating the needle.Conclusion Experimental observations show that bevel needle can get accurate puncture path and control of bone cement filling effect in the target region in the vertebra.

关 键 词：经皮椎体成形手术 斜面穿刺针 偏向分布 偏转 

分 类 号：R738.1[医药卫生—肿瘤]