本文關鍵詞： 腰椎 解剖學參數(shù) 經(jīng)皮椎體強化術 手術入路　出處：《中國修復重建外科雜志》2017年11期 　論文類型：期刊論文

【摘要】：目的測量單側經(jīng)橫突-椎弓根入路腰椎經(jīng)皮椎體強化術的相關解剖學參數(shù),探討該入路行椎體強化術的可行性與安全性。方法隨機選取60例患者共300個腰椎椎體,在X線片圖像和CT圖像上分別模擬單側經(jīng)傳統(tǒng)椎弓根入路(對照組)和單側經(jīng)橫突-椎弓根入路(研究組)完成經(jīng)皮椎體強化術600次。測量并比較同一手術入路L_1~L_5各椎體左右側及兩種手術入路L_1~L_5各椎體X線片圖像和CT橫斷面上穿刺點至椎體中線的距離、穿刺外偏角、穿刺角安全范圍和穿刺成功率。結果兩組L_1~L_5椎體左右側穿刺點至中線的距離均逐漸增大,其中對照組L_1、L_2右側距離顯著大于左側,研究組L_1、L_2、L_5右側距離顯著大于左側(P0.05);研究組L_1~L_5椎體左側或右側穿刺點至中線的距離均顯著大于對照組(P0.05)。研究組L_1~L_5右側最大外偏角、中點外偏角及L_1、L_2、L_4、L_5最小外偏角均顯著大于左側(P0.05)。L_1~L_5左右側最大外偏角、中點外偏角逐漸增大,最小外偏角變化不明顯,但所有外偏角均顯著大于對照組(P0.05)。兩組L_1~L_5左右側穿刺角安全范圍差異無統(tǒng)計學意義(P0.05);研究組L_5左右側穿刺角安全范圍顯著小于對照組(P0.05)。對照組和研究組所有椎體穿刺總成功率差異有統(tǒng)計學意義(χ~2=172.252,P=0.000);其中研究組L_1~L_4穿刺成功率顯著高于對照組(P0.05),L_5穿刺成功率兩組比較差異無統(tǒng)計學意義(P0.05)。結論單側經(jīng)橫突-椎弓根入路的穿刺點較傳統(tǒng)經(jīng)椎弓根入路偏外,穿刺外偏角更大,穿刺總成功率更高。單側經(jīng)橫突-椎弓根入路是一種較傳統(tǒng)經(jīng)椎弓根入路更安全、可靠的穿刺入路。
[Abstract]:Objective to measure the anatomical parameters of unilateral transtransverse process-pedicle approach for percutaneous lumbar vertebra enhancement. To explore the feasibility and safety of this approach, 300 lumbar vertebrae were randomly selected from 60 patients. Unilateral transpedicular approach (control group) and unilateral transtransverse process-pedicle approach (study group) were simulated on X-ray and CT images, respectively. Six hundred times of percutaneous vertebra augmentation were performed. We measured and compared the L1, L1, L5, L1, L5, L1, L5, L1, L5, and L1, L5, the same surgical approach, and the puncture points on the cross section of CT. Distance to the midline of the vertebra. Results the distance between the puncture point and the midline of L1 / L _ 5 vertebra in both groups was gradually increased, and the control group was L1 / L _ 1. The right side distance of L2 was significantly larger than that of left side, and the right side distance of the study group was significantly larger than that of the left side. The distance from left or right puncture point to midline in the study group was significantly larger than that in the control group (P 0.05). The minimum external deflection of L2L / L _ 4L _ S _ 5 is significantly higher than that of P0.05T / L _ 1 / L _ T _ 1 / L _ 1 / L _ 1 / L _ T _ 5. The angle of the outer deviation of the midpoint increases gradually, and the change of the minimum angle is not obvious. However, all the external angles were significantly higher than those of the control group (P 0.05). There was no significant difference in the safety range of the left and right puncture angles between the two groups (P 0.05). The safe range of L5 left and right puncture angle in the study group was significantly smaller than that in the control group (P 0.05). There was significant difference in the total success rate between the control group and the study group (蠂 2 172.252). P0. 000; The success rate of L1 and L4 puncture in the study group was significantly higher than that in the control group (P0.05). There was no significant difference in the success rate of L5 puncture between the two groups (P 0.05). Conclusion the puncture point of unilateral transtransverse process-pedicle approach is higher than that of the traditional transpedicular approach. Unilateral transtransverse procession-pedicle approach is a more safe and reliable approach than traditional transpedicular approach.
【作者單位】： 沈陽軍區(qū)總醫(yī)院骨科;
【基金】：浙江大學計算機輔助設計與圖形學國家重點實驗室開放課題(A1718) 中國科學院沈陽自動化所機器人學國家重點實驗室開放課題(2014-O12、2017-O01) 遼寧省博士科研啟動基金課題(201601389) 華中科技大學材料與模具技術國家重點實驗室開放課題(P2018-011)~~
【分類號】：R322.7;R687.3
【正文快照】： 2001年,Lieberman等[1]報道應用經(jīng)皮球囊椎體此后在臨床上開展該技術提供解剖學參考。報告后凸成形術(percutaneous kyphoplasty,PKP)能有如下。效緩解椎體壓縮性骨折患者的疼痛,改善后凸畸1材料與方法形,此后該技術在臨床上得以普遍開展。經(jīng)典的椎體強化術是雙側經(jīng)椎弓根入路

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