椎体后凸成形术棘突定位穿刺点与穿刺轨道的研究

The clinical significance of locating percutaneous puncturing sites and track according to the spinous process

目的研究经皮椎弓根穿刺轨道的三维影像学特点,探讨在影像监视下椎弓根穿刺的安全操作范围。方法过椎弓根腰部中心点做椎体前下1/3中心点连线为虚拟“标准穿刺轨道”,观察这一轨道各参照点在不同平面上的投影与椎弓根腰部投影及棘突的位置关系,测量进针点与棘突在水平面上的距离。结果穿刺轨道各参照点在水平面上的投影与椎弓根腰部投影无交叉,利于椎弓根穿刺时的安全监测;经皮穿刺点由侧位、水平位穿刺轨道与棘突的位置关系进行确定,在侧位X线片上应位于患椎的上一棘突。水平位的棘突旁开距从胸椎至腰椎逐渐递增,T4～T8经椎弓根外缘为(2.96±0.38)cm至(3.27±0.43)cm;T9～L1经椎弓根内缘为(3.04±0.37)cm至(3.85±0.48)cm,经椎弓根外缘为(3.66±0.47)cm至(4.78±0.56)cm;L2￣L5为(4.05±0.48)cm至(7.85±1.02)cm。(3)左右侧与男女组间差异无统计学意义(P>0.05)。结论对穿刺轨道的研究便于对椎弓根穿刺的安全监视;经椎弓根“标准穿刺轨道”安全可靠;经皮椎弓根穿刺定位点可通过棘突的体表位置进行定位。

Objective To explore the characteristic of track of percutaneous transpedieular puncture on three-dimensional images and its safe procedure under image guidance, Methods The standard track was defined as a line that connected the centre of pedicular isthmus and the centre of antero-inferlor 1/3 part of the vertebraa] body. The projeetion of reference sites of this track on three-dimensional images was observed according to the pedicular isthmus and the spinous process. The horizontal distances between percutaneous puncturing sites and spinous process were measured. Results 1 ）The horizontal projection of reference sites of this track did not overlap that of the pedicular isthmus, and this was convenient for the monitoring of the pediele during puncture under image guidance. 2）According to the spinous process, the sagittal and horizontal projection of the pereutaneous puncturing sites was fixed. On sagittal plane, the puncturing sites overlapped the upper adjacent spinous process. On horizontal plane, the distance between the puncturing sites and the spinous process increased from thoracic to lumbar spine. From T4-T8, it varied from （2.96±0.38）cm to （3.27±0.43）em with parapedieular approach. From T9-L1, it varied from （3.04±0.37） cm to （3.85±0.48） cm with transpedicular approach, and from（3.66±0.47）cm to （4.78±0.56）cm with parapedicular approach. From L2-L5, it varied from （4.05±0.48） cm to （7.85±1.02） cm. 3）There were no significant differenee of these parameters between male and female groups or between left and right sides （P 〉0.05）. Conclusion The study of the eharacteristie of track of pereutaneous transpedieular puncture is good for the safe proedure under image guidance. The standard track is safe for transpedieular or parapedicular puncture. The percutaneous transpedieular puncturing sites can be located according to the spinous process.