经横突上缘和椎弓根外进入椎体侧壁入路在椎体成形术中的研究  

Approach through supra-transverse and extra-pedicular to the lateral wall of the vertebral body in vertebroplasty

作　　者：李高磊 朱宇[1] 李毅[1] 李杰[1] 樊晓韩 卢文龙 黎少言 Li Gaolei;Zhu Yu;Li Yi;Li Jie;Fan Xiaohan;Lu Wenlong;Li Shaoyan(Department of Orthopaedics,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院骨科,郑州450014

出　　处：《中华实验外科杂志》2024年第7期1437-1441,共5页Chinese Journal of Experimental Surgery

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20230331)。

摘　　要：目的验证经横突上缘、椎体侧壁穿刺在椎体成形术中的可行性及安全性。方法回顾性收集并分析42例存储与郑州大学第二附属医院影像资料库中的腹部和胸部CT血管造影(CTA)影像学数据,利用3Dslicer软件重建T6~L3椎体及其节段动脉,利用3Dslicer软件进行模拟穿刺,测量穿刺针与矢状面夹角A-1、与横断面夹角A-2、进针点距离节段动脉最近距离Le~a及可安全穿刺区域的面积的数据A,并将每节椎体左右两侧数据进行配对资料t检验分析。结果穿刺针与矢状面夹角A-1在T6~T12为(31.2±1.4)°~(33.0±1.1)°之间,在L1~3为(27.3±1.7)~(28.3±1.5)°之间;穿刺针与横断面夹角A-2在T6~T12为(31.5±1.0)°~(31.5±1.0)°之间,在L1~3为(38.8±1.2)°~(39.9±1.2)°之间;进针点距离节段动脉Le~a在T6~T12为(9.2±0.7)mm~(12.0±1.4)mm之间,在L1~3为(12.0±1.1)mm~(12.4±1.3)mm之间;穿刺安全区域面积A在T6~T12为(21.40±0.61)mm^(2)~(69.00±6.48)mm^(2)之间,在L1~3为(108.23±5.80)mm^(2)~(123.86±8.53)mm^(2)之间;T6~L3各节椎体左右两侧各参数t检验,P值均>0.05,差异无统计学意义。结论在经皮穿刺椎体成形术时,经横突上缘和椎弓根外进入椎体侧壁穿刺是一种安全可行的入路。Objective To verify the feasibility and security of puncture through supra-transverse and extra-pedicular to the lateral wall of the vertebral body in vertebroplasty.Methods A total of 42 cases of abdominal and thoracic CTA imaging data stored in the image database of the Second Affiliated Hospital of Zhengzhou University were retrospectively collected and analyzed.The 3D slicer software was used to re-construct the T6-L3 vertebral body and its segmental arteries,and simulate the puncture.Also,the includ-ed angle A-1 between the puncture needle and the sagittal plane,the included angle A-2 between the punc-ture needle and the transverse plane,the closest distance Le-a between the insertion point and the segmen-tal artery,and area A of the safe puncture position were measured.Finally,SPSS 23.O was adopted to cal-culate the mean±standard deviation(x±s)of all parameters,and the data on the left and right sides of each vertebral body segment were analyzed by paired t-tests.Results The included angle A-1 between the puncture needle and the sagittal plane ranged from(31.2±1.4)°to(33.0±1.1)°on T6-T12,and from(27.3±1.7)°to(28.3±1.5)°on L1-3.The angle A-2 between the puncture needle and the transverse plane ranged from(31.5±1.0)°to(31.5±1.0)°on T6-T12,and from(38.8±1.2)°to(39.9±1.2)on L1-3.The distance between the insertion point and the segmental artery Le-a ranged from(9.2±0.7)mm to(12.0±1.4)mm on T6-T12,and from(12.0±1.1)mm to(12.4±1.3)mm on L1-3.The area A of the safe puncture position ranged from(21.40±0.61)mm^(2)to(69.00±6.48)mm on T6-T12,and from(108.23±5.80)mm^(2)to(123.86±8.53)mm^(2)on L1-3.The P-values of t-tests for each parame-ter on the left and right sides of the T6-L3 vertebral body were greater than 0.05,and the difference had no statistical significance.Conclusion When performing percutaneous vertebroplasty,puncture through su-pra-transverse and extra-pedicular to the lateral wall of the vertebral body is a safe and feasible approach.

关 键 词：椎体成形术 穿刺角度 穿刺安全面积 

分 类 号：R687.3[医药卫生—骨科学]