经皮椎体后凸成形术中单侧经椎弓根穿刺角度与骨水泥分布情况的关系

Percutaneous kyphoplasty:obeservations between unipedicular puncturing angle and bone cement distribution

目的探讨单侧经椎弓根穿刺行经皮脊柱后凸成形术(PKP)时穿刺角度与椎体内骨水泥分布情况的关系。方法收集采用PKP治疗的骨质疏松性椎体压缩性骨折(OVCFs)患者112例,病变椎体为T10～L4共147节,术后第2～3天注射椎体行CT扫描,在PACS影像浏览器IE 4.0上根据骨水泥分布情况进行穿刺角度测量。结果单侧穿刺骨水泥中心分布119节椎体,偏心分布28节椎体。T10骨水泥中心分布时穿刺角度为12.56°～16.23°(14.79°±1.32°),偏心分布时穿刺角度为10.26°～15.71°(12.38°±1.18°);T11～L2单侧穿刺骨水泥中心分布时的穿刺角度为15.24°～26.40°(17.86°±2.10°),偏心分布时穿刺角度为10.38°～14.76°(13.5°±1.15°);L3骨水泥中心分布时穿刺角度为14.69°～22.57°(17.56°±2.05°),穿刺角度在10.58°～16.40°(11.63°±1.27°)时骨水泥呈偏心分布;L4椎体骨水泥中心分布时内倾角度为15.57°～24.60°(18.54°±2.16°),偏心分布时角度为13.24°～17.25°(15.34°±1.21°)。结论掌握适当的内倾角度(15°～20°),单侧穿刺行PKP能够使骨水泥在椎体内中心分布,减少手术时间和风险,临床效果满意。

Objective To explore relationship between cement distribution with introversional angle in unipedicular percutanenous kyphoplasty. Methods 112 patients with osteoporotic vertebral compression fractures were collected. 147 vertebraes ranged from T10 to L4. CT scan was performed postoperation and the introversional angle was measured by PACS imaging browser. Results Cement was in center of dispersal in 119 vertebraes and eceenter in 28 vcrtebraes. In T10, the introversional angle was 12. 56°- 16. 23°（ 14. 79°± 1.32°） when cement distribute in center and 10. 26° - 15.71°（ 12. 38° ± 1.18°） when cement distribute in eceenter; From T11 to L2, the introversional angle was 15.24° - 26.40° （ 17.86°± 2. 10°） when cement distribute in center. The angle was 10. 38° - 14. 76° （ 13.5°± 1.15° ） when cement in bias. In L3 ,the angle was 14. 69° - 22. 57° （ 17.56°± 2.05° ） when cement distribute in center and 10. 58 ° - 16.40°（ 11.63 °± 1.27 °）when cement distribute in eecenter ;In L4, the angle was 15.57° -24. 60°（ 18.54 ± 2. 16° ） when cement distribute in center and 13.24° - 17.25° （ 15.34°± 1.21° ） when cement distribute in eccenter. Conclusions With proper introversional angle （15° -20°）, unipedicular pcrcutanenous kyphoplasty can make cement distribute in vertebral center. Moreover, operation-time and risk can be reduced, clinical effects were satisfying.