螺旋CT数据简易化处理在PLD术中L_5~S_1椎间盘穿刺入路选择的应用价值

The Application of Simple Processing of Spiral CT Data in Selecting L_5- S_1 Intervertebral Disc Puncture Approach for the Performance of Percutaneous Lumbar Discectomy

目的 探索螺旋CT数据简易化处理在经皮腰椎间盘切吸术（PLD）中L5~S1椎间盘穿刺入路选择的价值。方法 搜集2007年6月至2010年6月于新乡医学院第一及第二附属医院行PLD的L5~S1椎间盘突出症患者196例。按不同L5~S1椎间盘穿刺路径选择将其分为A、B两组,A组为2009年6月以前根据既往常规穿刺点范围、穿刺参数,经皮椎间盘穿刺施术的病例,共115例;B组：为2009年6月以后经螺旋CT数据处理、选择的穿刺路径施术的病例,共81例。测量与穿刺路径相关的解剖结构数据,经相关统计学分析,探索其内在规律。分析A、B两组在穿刺点定位用时、穿刺到位用时、穿刺次数、术中X线用时之间的差异性。结果 穿刺深度、重组矢状面各层椎间隙宽度平均值、L5~S1椎间盘中心厚度、L5椎体中心厚度、L5两侧关节突最大距离、L5两侧横突最大宽度及最大距离、L5两侧横突最大距离、髂骨最高点与L5椎体终板上缘中心点高度差的标准差和变异系数偏大。定位用时分别为A组（1.09±0.22）min,B组（1.04±0.40）min（P〉0.05）;穿刺到位用时A组（3.29±1.53）min,B组（2.79±1.07）min（P〈0.05）;穿刺平均次数A组4.41±1.91,B组2.23±1.09（P〈0.05）;术中X线用时A组（11.9±5.2）min,B组（6.7±3.6）min（P〈0.05）。结论 穿刺前对与穿刺路径相关的解剖结构进行螺旋CT数据简易化处理不增加体表穿刺点定位用时,明显缩短经皮穿刺到位用时、穿刺次数及术中X线用时,并能最大程度减少并发症,值得临床推广。

Objective To evaluate simple processing of spiral CT data in selecting L5 -S1 intervertebral disc puncture approach for the performance of percutaneous lumbar discectomy （PLD）. Methods A total of 196 patients with L5 - S1 disc protrusion, who were admitted to the First or the Second Affiliated Hospital of Xinxiang Medical College during the pe- riod from 2007 June to 2010 June to receive PLD, were enrolled in this study. According to the puncture approach used in PLD, the patients were divided into two groups. For patients of group A （ n = 115 ） conventional puncturing method （ inclu- ding puncturing extent and parameters as used before June 2009 ） was employed, while for patients of group B （ n = 81 ） the puncturing path was determined by spiral CT data; the puncture-related anatomical structures were measured, which was statistically analyzed to clarify the inherent relationship. The used time for puncture point positioning, the used time for puncturing to right place, the number of puncturing times and the X-ray exposure time for the procedure were recorded, and the results were compared between the two groups. Results （ 1 ） Puncture depth, the mean width of intervertebral space measured on sagittal reconstruction image, the central thickness of Ls - S1 disc, the central thickness of L5 vertebra, the maximum distance between Ls bilateral facets, the maximum width of L5 vertebra, and the maximum distance of between L5 bilateral transverse processes, the difference in the height between the highest point of ilium and center point of L5 end- plate, etc. were determined. The results showed that the standard deviation and the coefficient of variation were obviously larger. （2） The used time for puncture point positioning in group A and B was （ 1.09 ± 0.22 ） min and （ 1.04 ± 0.40） min respectively （ P 〉 0.05 ） ; the used time for puncturing to the right place in group A and B was （ 3.29 ± 1.53 ） rain and （2.79 ± 1.07） min（P 〈0.05） respectively; the mean number of puncturing times in group A and B was 4.41 ± 1.91 and 2.23 ± 1.09 respectively （ P 〈 0.05 ） ; and the X-ray exposure time for the procedure in group A and B was （ 11.9 ± 5.2） rain and （ 6.7 ± 3.6） rain respectively （ P 〈 0.05 ）. Conclusion Preoperative simple processing of spiral CT data about puncture-related anatomical structures can significantly save the time for puncturing to the right place. The number of punc- turing times, the X-ray exposure time during the procedure, and the complications can be reduced to the greatest possible degree. Therefore, this technique should be recommended in the clinical practice.