单侧经皮椎体后凸成形术进针角度的测量与应用

Measurement and applied research of the puncture angle in unilateral puncture in percutaneous kyphoplasty

目的探讨椎体成形术术前测量X线片、计算穿刺角度对提高单侧穿刺成功率的意义。方法选取45例新鲜骨质疏松性椎体压缩骨折患者共72椎,术前测量双侧椎弓根投影外、内缘之间的距离、上关节突后缘至椎体后缘的距离、椎体前后缘的距离,测量(计算)上关节突后缘至椎体中央处的距离,根据反正切函数计算出穿刺角度及其安全范围。结果 45例手术均顺利完成,一次穿刺成功率达95.8%。椎体前缘高度恢复率平均为41.2%±22.1%,椎体中线高度恢复率平均为45.6%±20.7%,椎体后凸矫正率平均为43.8%±22.7%,与术前比较差异有统计学意义(P<0.05)。无骨水泥压迫脊髓、神经根等并发症,随访期内椎体高度无再丢失。结论术前通过X线片测量穿刺角度有利于精确手术操作,缩短手术时间,降低手术风险,提高单侧穿刺成功率。

Objective To explore the value of the success rate in unilateral puncture in PKP about preoperative measurement of X-ray and calculating the puncture angle. Methods The group selected fresh osteoporotic vertebral compression fractures in 45 cases （72 vertebrae）. The distance preoperative between inner and outer edge of bilateral pedicle projection, posterior edge of the superior articular process to the posterior edge of vertebral and vertebral cen- tral facet, the distance of the trailing edge in the vertebral body were measured. According to the inverse tangent function, the puncture angle and its security range were calculated. Results 45 surgeries were successfully completed. The average anterior vertebral height restoration rate was 41.2% ± 22. 1% , the average vertebral body midline height restoration rate was 45.6% ± 20.7%, and the average vertebral kyphosis correction rate was 43.8% ± 22. 7%. It was of great statistical significant to compare with all of the above preoperative （P 〈 0.05 ）, without spinal cord, nerve root, and other complications compression caused by bone cement. The postoperative follow-up showed vertebral height was remained. Conclusions Preoperative puncture angle measurement via X-ray photography conducive to the surgical procedure is accurate, requires shorter operative time, and reduce the X-ray radiation and the risk of surgery, which improve the success rate of unilateral puncture.