本文選題：經(jīng)皮椎體后凸成形術(shù) + 胸腰段��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:通過對(duì)胸腰段(T10-L2)各節(jié)段椎體CT影像學(xué)上的相關(guān)測(cè)量,研究出胸腰段各節(jié)段椎體行經(jīng)皮椎體后凸成形術(shù)(percutaneous kyphopoplasty,PKP)經(jīng)單側(cè)穿刺入路的最佳穿刺外展角度及皮膚穿刺點(diǎn)距后正中線的距離,為臨床骨科醫(yī)師行單側(cè)PKP治療患者時(shí)提供參考。方法:隨機(jī)選取2014年10月至2016年5月來我院診療的100例非骨折胸、腰椎患者,男性50例,女性50例;在我科PACS系統(tǒng)中調(diào)取患者的胸、腰椎CT,查看CT影像學(xué)檢查結(jié)果并進(jìn)行回顧性分析。針對(duì)胸腰段各節(jié)段椎體的CT圖像,我們選取CT軸位像上兩側(cè)椎弓根最寬的那一層,在該層上做椎體前后正中線段,并在該線段上選取前1/3的那一點(diǎn),過該點(diǎn)做垂線,該垂線與椎體兩側(cè)各有一交點(diǎn),任選一點(diǎn)和正中線段于椎體前側(cè)的交點(diǎn)及正中線段的前1/3點(diǎn)構(gòu)成一個(gè)三角形,即為穿刺針?biāo)_(dá)理想?yún)^(qū)域,做此三角形的重心,為理想?yún)^(qū)域的代表點(diǎn),以此為單側(cè)穿刺時(shí)穿刺針?biāo)_(dá)的目標(biāo)點(diǎn)進(jìn)行模擬穿刺,穿刺軌跡距椎弓根內(nèi)側(cè)壁距離為套管的半徑(2mm),此時(shí)穿刺軌跡與矢狀面的夾角即為最佳外展角,測(cè)量T1O至L2各節(jié)段椎體經(jīng)單側(cè)穿刺入路行PKP手術(shù)時(shí)穿刺針的最佳外展角度及皮膚穿刺點(diǎn)距后正中線的距離。統(tǒng)計(jì)100例患者的性別、年齡、身高、體重,并探究在胸腰段各節(jié)段椎體行PKP經(jīng)單側(cè)穿刺入路的最佳外展角度及皮膚穿刺點(diǎn)距后正中線的距離與性別、年齡、身高、體重是否有相關(guān)性。結(jié)果:胸腰段各節(jié)段椎體經(jīng)單側(cè)穿刺入路行PKP手術(shù)的最佳外展角度及皮膚穿刺點(diǎn)距后正中線距離的測(cè)量結(jié)果有很大差異(P0.05)。在T10椎體PKP單側(cè)穿刺入路的最佳外展角度平均值為(31.48±0.66)°;在T11椎體外展角度平均值為(33.19±0.70)°;在T12椎體外展角度平均值為(34.83±0.52)°;在L1椎體外展角度平均值為(36.81±0.67)°;在L2椎體外展角度平均值為(38.22±0.71)°。PKP經(jīng)單側(cè)入路在最佳穿刺外展角度的情況下皮膚穿刺點(diǎn)距后正中線的距離,在T10椎體平均距離為(43.42±2.07)mm;在T11椎體平均距離為(49.06±2.88)mm;在T12椎體平均距離為(53.70±1.72)mm;在L1椎體平均距離為(58.63±1.88)mm;在L2椎體平均距離為(63.33±2.57)mm。結(jié)論:PKP經(jīng)單側(cè)穿刺入路的最佳外展角度及皮膚穿刺點(diǎn)距后正中線的距離與胸腰段各節(jié)段椎體之間有很大相關(guān)性。從T10至L2椎體,PKP經(jīng)單側(cè)穿刺入路的外展角度及皮膚穿刺點(diǎn)距后正中線的距離越來越大。在T11、L1節(jié)段,相同節(jié)段椎體女性外展角度平均比男性大約多出1°;在T10、T12、L2節(jié)段,男女差異不顯著。在T10至L2節(jié)段,相同節(jié)段椎體皮膚穿刺點(diǎn)距后正中線距離男性平均比女性大約多出3.6mm。而外展角及皮膚穿刺點(diǎn)距后正中線的距離與病人年齡、身高、體重之間沒有明顯相關(guān)性。本研究的測(cè)量結(jié)果可為臨床骨科醫(yī)師在利用PKP單側(cè)穿刺入路治療老年骨質(zhì)疏松性椎體壓縮骨折時(shí)提供參考。
[Abstract]:Objective: to measure the CT correlation of thoracic and lumbar vertebrae (T10-L2). To study the optimal puncture outreaching angle and the distance between the skin puncture point and the posterior median line of percutaneous kyphopoplastyplasty (percutaneous kyphopoplasty-PKP) in thoracolumbar vertebrae, which provides reference for clinical orthopedic surgeon to treat patients with unilateral PKP. Methods: from October 2014 to May 2016, 100 cases of non-fracture chest, including 50 males and 50 females, were selected from our hospital from October 2014 to May 2016. Ct findings of lumbar spine were reviewed and analyzed retrospectively. For the CT images of the thoracolumbar vertebrae, we selected the widest layer of the pedicle on both sides of the spine, made the anterior and posterior midline of the vertebrae in this layer, and chose the first third of the point on the segment to be a perpendicular line. The perpendicular line has an intersection with each side of the vertebrae, and any point and median line at the intersection of the front side of the vertebra and the first third of the midline constitute a triangle, that is, the ideal region reached by the puncture needle, making the center of gravity of the triangle. As the representative point of ideal region, the target point reached by the puncture needle during unilateral puncture is simulated puncture. The distance from the puncture track to the inner wall of the pedicle is the radius of the casing (2mm), and the angle between the puncture trajectory and the sagittal plane is the best outreaching angle. The optimal outreaching angle of puncture needle and the distance from the point of skin puncture to the posterior median line were measured during the operation of PKP in each segment of T _ (10) to L _ (2) vertebrae. The sex, age, height and weight of 100 patients were counted, and the best abduction angle of PKP through unilateral puncture approach and the distance between skin puncture point and posterior median line, gender, age, height, were investigated in all vertebrae of thoracolumbar segment. Whether weight is relevant. Results: there were significant differences in the measurement of the optimal abduction angle and the distance between the skin puncture points and the posterior median line of the thoracolumbar vertebrae through unilateral puncture approach (P0.05). The average optimal abduction angle of PKP in T10 vertebral body was (31.48 鹵0.66) 擄, that in T11 was (33.19 鹵0.70) 擄, that in T12 was (34.83 鹵0.52) 擄, that in L1 was (36.81 鹵0.67) 擄, that in L2 was (36.81 鹵0.67) 擄, that in T12 was (34.83 鹵0.52) 擄, in that of vertebral body was (36.81 鹵0.67) 擄, that in T11 was (33.19 鹵0.70) 擄, that in T12 was (34.83 鹵0.52) 擄. The average value was (38.22 鹵0.71) 擄. The distance between the skin puncture point and the posterior median line under the condition of optimal puncture outreaching angle through the unilateral approach. The mean distance in T10, T11, T12, L1 and L2 were (43.42 鹵2.07) mm, (49.06 鹵2.88) mm, (53.70 鹵1.72) mm, (58.63 鹵1.88) mm and (63.33 鹵2.57) mm, respectively. Conclusion the optimal outreaching angle and the distance between the skin puncture point and the posterior median line are closely related to the thoracolumbar vertebrae. From T10 to L2 vertebrae PKP through unilateral puncture approach of the abduction angle and skin puncture point from the posterior median line distance is increasing. In the T11L 1 segment, the female abduction angle of the same segment was about 1 擄higher than that of the male, but there was no significant difference between the male and the female at the T10 T 12 L 2 segment. In the T10 to L2 segments, the average distance from the posterior median line to the skin puncture point in the same vertebrae is about 3.6 mm. longer in males than in females. There was no significant correlation between the outreaching angle and the distance between the skin puncture point and the posterior median line and the patient's age, height and weight. The results of this study may provide a reference for clinical orthopedic physicians in the treatment of senile osteoporotic vertebral compression fractures with PKP unilateral puncture approach.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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