单侧经横突-椎弓根入路腰椎椎体强化术的解剖学研究

An anatomical study of lumbar unilateral transverse process-pedicle percutaneous vertebral augmentation

目的测量单侧经横突-椎弓根入路腰椎经皮椎体强化术的相关解剖学参数,探讨该入路行椎体强化术的可行性与安全性。方法随机选取60例患者共300个腰椎椎体,在X线片图像和CT图像上分别模拟单侧经传统椎弓根入路(对照组)和单侧经横突-椎弓根入路(研究组)完成经皮椎体强化术600次。测量并比较同一手术入路L_1~L_5各椎体左右侧及两种手术入路L_1~L_5各椎体X线片图像和CT横断面上穿刺点至椎体中线的距离、穿刺外偏角、穿刺角安全范围和穿刺成功率。结果两组L_1~L_5椎体左右侧穿刺点至中线的距离均逐渐增大,其中对照组L_1、L_2右侧距离显著大于左侧,研究组L_1、L_2、L_5右侧距离显著大于左侧(P<0.05);研究组L_1~L_5椎体左侧或右侧穿刺点至中线的距离均显著大于对照组(P<0.05)。研究组L_1~L_5右侧最大外偏角、中点外偏角及L_1、L_2、L_4、L_5最小外偏角均显著大于左侧(P<0.05)。L_1~L_5左右侧最大外偏角、中点外偏角逐渐增大,最小外偏角变化不明显,但所有外偏角均显著大于对照组(P<0.05)。两组L_1~L_5左右侧穿刺角安全范围差异无统计学意义(P>0.05);研究组L_5左右侧穿刺角安全范围显著小于对照组(P<0.05)。对照组和研究组所有椎体穿刺总成功率差异有统计学意义(χ~2=172.252,P=0.000);其中研究组L_1~L_4穿刺成功率显著高于对照组(P<0.05),L_5穿刺成功率两组比较差异无统计学意义(P>0.05)。结论单侧经横突-椎弓根入路的穿刺点较传统经椎弓根入路偏外,穿刺外偏角更大,穿刺总成功率更高。单侧经横突-椎弓根入路是一种较传统经椎弓根入路更安全、可靠的穿刺入路。

Objective To measure the anatomical parameters related to lumbar unilateral transverse processpedicle percutaneous vertebral augmentation, and to assess the feasibility and safety of the approach. Methods A total of 300 lumbar vertebral bodies of 60 patients were randomly selected, and vertebral augmentation were simulated 600 times on X-ray and CT image with unilateral conventional transpedicle approach（control group） and unilateral transverse process-pedicle approach（experimental group）. The distance between the entry point and the midline of the vertebral body, the puncture inner inclination angle, the safe range of the puncture inner inclination angle, and the puncture success rate were measured and compared between the left and right with the same approach, and between the two approaches.Results The distance between the entry point and the midline gradually increased from L_1 to L_5 on both sides in the 2 groups. In the control group, the right sides distance of L_1 and L_2 was much longer than the left sides, and the right sides distance of L_1, L_2, and L_5 was much longer than the left sides in the experimental group（P0.05）; the distance of the experimental group between the entry point and the midline was much longer than the control group regardless of thesides from L_1 to L_5（P0.05）. In the experimental group, the right maximum inner inclination angle from L_1 to L_5, the right middle inner inclination angle from L_1 to L_5, and the right minimum inner inclination angle from L_1, L_2, L_4, L_5 were significantly larger than the left side（P0.05）. The maximum inner inclination angle and the middle inner inclination angle presented increased tendency, the tendency of minimum inner inclination angle was ambiguous, however, the all inner inclination angles were much larger than those in control group among the different lumbar levels（P0.05）. There was no significant difference of the safe range of the puncture inner inclination angle between 2 sides in 2 groups at L_1 to L_5（P0.05）; the safe range angle in experimental group at L_5 was significantly smaller than that in control group（P0.05）.The difference in total puncture success rate of all lumbar levels was significant between the experimental group and the control group（χ~2=172.252, P=0.000）; the puncture success rates of the experimental group were higher than those in the control group form L_1 to L_4（P0.05）, but no significant difference was found in the puncture success rate between 2 groups at L_5（P0.05）. Conclusion Compared with the unilateral conventional transpedicle approach, the entry point of the unilateral transverse process-pedicle approach is localized outside, the puncture inclination angle is wider, and the puncture success rate is higher. It shows that the unilateral transverse process-pedicle approach is safer and more reliable than the unilateral conventional transpedicle approach.