单侧椎体成形术皮肤穿刺点及角度影像学测量的临床应用

Imaging measurement of skin puncturing point and angle for unipedicular vertebroplasty and clini-c~ appHcafion

目的探讨单侧椎体成形术最佳皮肤穿刺点及角度影像学测量的临床应用，为临床工作提供参考。方法在多排螺旋CT机上随机选择的T（胸椎）、L（腰椎）CT片各200例，测量脊柱易发生骨折的位置较高的胸6至低位的腰5椎体的椎弓根轴线与椎体前、中1／3交界处轴线的夹角，胸椎另外还测量椎弓根外途径即肋椎关节穿刺途径的角度，同时测量棘突旁开距离。结果胸椎经椎弓根穿刺，穿刺针与人体矢状面成角（28．24±3．8）°，棘突旁开距离（31．64±5．4）mm，经椎弓根外即肋椎关节途径穿刺角度（35±3．4）°，棘突旁开距离（55．2±5．3）mm。腰椎经椎弓根穿刺，腰椎1—4角度为（29．3±5．6）°，棘突旁开距离（38．4±4．5）mm。腰椎5角度为（39．2±3．3）°，棘突旁开距离（71．6±6．2）mm。结合临床实践，认为胸椎椎弓根途径棘突旁开距离30mm作为实际的皮肤穿刺点，经肋椎关节途径时40mm，腰椎1-4为45mm，腰椎5为60mm为宜。结论根据测量的数据并结合临床实践，能够指导临床快速、安全、准确完成手术，减少手术的并发症及创伤，节约材料及费用，缩短手术时间。

Objective To explore puncture point and angle of skin for unipedicular vertebroplasty by imaging measurement and combining clinical practice in order to provide reference for clinical work. Methods CT images of thoracic and lumbar vertebrae of imaged with muhislice helical CT were random chosen. From high to low position vertebrae of easy fracture T6 to -L5 , its angle between vertebral pediclestalk line and 1/3 of vertebral body stalk line fore and median of point of intersection was measured. The angle of sternocostal joints route was also measured. At the same time the distance between site of skin puncture and spinous process was measured. Results The angle between the thoracic vertebraI pedicle and sagittal section was （28. 2 ± 3.8） ±, the lateral distance of the spinous process was （31.6 ± 5.4） mm. Theangle of thoracic vertebraI pedicle lateral route was （35 ± 3.4） o, the distance was （55.2 ± 5.3 ） mm. In the lumbar vertebrae pedicle route, the angle of LI -L4 was （ 29. 3 ± 5.6 ） ±, the distance was （ 38.4 ± 4. 5 ） mm L5 was （39.2 ± 3.3 ） o, the distance was （ 71.6 4±6.2） mm. Combining clinical practice, the lateral distance of the spinous process in thoracic vertebraI pedicle route, the best puncture point was 30 mm, in thoracic vertebraI pedicle lateral route it was 40 mm, in L1 -L4 it was 45 mm, in Ls it was 60 mm. Conclu- sions The unipedicular vertebroplasty can be performed rapidly, accurately and safely, and it reduces complications, cost and time.