BACKGROUND Thoracic intervertebral foramen puncture is the key step for interventional therapy on the thoracic nerve roots or dorsal root ganglia.The anatomical features of the thoracic spine are complex,and puncture ...BACKGROUND Thoracic intervertebral foramen puncture is the key step for interventional therapy on the thoracic nerve roots or dorsal root ganglia.The anatomical features of the thoracic spine are complex,and puncture injury to the pleura,blood vessels,spinal cord,and other tissues may cause serious complications.The spatial anatomical characteristics and related parameters for thoracic intervertebral foramen puncture remain poorly understood.AIM To observe and summarize the spatially applied anatomical characteristics for intervertebral foramen puncture on different vertebral segments.METHODS A total of 88 patients(41 males and 47 females)who underwent thoracic minimally invasive interventional treatment at Nanjing Drum Tower Hospital from January 2019 to June 2020 were included.Computed tomography images of 167 thoracic vertebral segments scanned in the prone position were collected.The width of the intertransverse space(D_(P)),the height of the rib neck/head above the lower transverse process(D_(R)),the width of the lateral border of the articular process/lamina(W_(P)),and the width of the posterior border of the vertebral body(W_(V))were measured.At the upper 1/3 of the intervertebral foramina,the horizontal inclination angle(α)from the lateral border of the articular process/lamina to the posterolateral border of the vertebral body was measured.The ratios D_(R)/D_(P) and W_(P)/W_(V) were calculated.The intervertebral foramen parameters were compared between segments.RESULTS No rib head/neck occlusion(D_(R)/D_(P)>0)was found in the intertransverse spaces of T1-2 and T12-L1.The incidence of occlusion for the upper thoracic segments(T1-5,n=138),middle thoracic segments(T5-9,n=116),and lower thoracic segments(T9-L1,n=80)were 76.81%,100%,and 82.50%,respectively.The incidence of occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments(P<0.05).The incidence of>1/2 occlusion(D_(R)/D_(P)>1/2)for the upper,middle,and lower thoracic segments was 7.97%,74.14%,and 32.50%,respectively.The incidence of>1/2 occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments(P<0.05).W_(P) was longer than W_(V) on T1-2 to T9-10 and shorter than W_(V) on T10-11 to T12-L1.The horizontal puncture angle(α)into the external opening of the intervertebral foramina was positively correlated with the segments of the thoracic vertebrae from the cephalic to caudal portion(left:r=0.772,P<0.01;right:r=0.771,P<0.01),and the horizontal inclination angle for T11-12 and T12-L1 was 90°.CONCLUSION It is necessary to identify the spatial impact of the rib head/neck on the puncture path of the intervertebral foramina and design appropriate puncture angles for different segments.展开更多
目的:为减小胸椎间孔穿刺时发生气胸、脊髓损伤等并发症的风险,基于CT(computed tomography)影像测量数据,分析不同性别、年龄和体重指数(body mass index,BMI)病人的差异,探究不同节段的变化规律。方法:选取中日友好医院影像数据库中18...目的:为减小胸椎间孔穿刺时发生气胸、脊髓损伤等并发症的风险,基于CT(computed tomography)影像测量数据,分析不同性别、年龄和体重指数(body mass index,BMI)病人的差异,探究不同节段的变化规律。方法:选取中日友好医院影像数据库中180例成年住院病人胸部CT影像,以T_(2)~T_(12)左侧椎间孔(intervertebral foramen,IF)为穿刺靶点,选取可清楚显示胸椎间孔的CT横断面,模拟椎间孔穿刺操作,测量旁开距离、穿刺角度、穿刺深度和椎间孔至后正中线距离,计算出可行的安全穿刺范围,分析不同性别(男性、女性)、年龄(青年、中年、老年)、BMI(非超重、超重)的测量结果。结果:不同性别的病人相比,男性在各节段的旁开距离和穿刺深度均明显高于女性,在上胸段的穿刺角度低于女性,椎间孔至正中线距离明显大于女性;不同年龄的病人相比,老年病人在T_(2~3)至T_(4~5)节段的最小旁开距离大于青年、中年病人,在T_(3~4)和T_(4~5)节段的穿刺角度小于青年、中年病人;不同BMI病人相比较,超重病人在各节段的旁开距离、穿刺深度均高于非超重病人,在T_(9~10)以上节段的穿刺角度小于非超重病人。从总体规律来看,椎间孔至后正中线距离在T_(5~6)和T_(6~7)最短,旁开距离、穿刺角度、穿刺深度和椎间孔至正中线距离均在中胸段出现极值,向两侧逐渐减小或增大。结论:胸椎穿刺的旁开距离、穿刺角度、穿刺深度由T_(2~3)至T_(11~12)有一定变化规律,各参数在不同性别、年龄、BMI病人之间存在差异,对于临床进行不同节段和人群的椎间孔穿刺操作有一定参考意义。展开更多
基金Supported by The Key R&D Project in Jiangsu Province,No.BE2017603 and No.BE2017675the Key Program of Medical Science and Technology Development Projects in Nanjing,No.ZKX19016.
文摘BACKGROUND Thoracic intervertebral foramen puncture is the key step for interventional therapy on the thoracic nerve roots or dorsal root ganglia.The anatomical features of the thoracic spine are complex,and puncture injury to the pleura,blood vessels,spinal cord,and other tissues may cause serious complications.The spatial anatomical characteristics and related parameters for thoracic intervertebral foramen puncture remain poorly understood.AIM To observe and summarize the spatially applied anatomical characteristics for intervertebral foramen puncture on different vertebral segments.METHODS A total of 88 patients(41 males and 47 females)who underwent thoracic minimally invasive interventional treatment at Nanjing Drum Tower Hospital from January 2019 to June 2020 were included.Computed tomography images of 167 thoracic vertebral segments scanned in the prone position were collected.The width of the intertransverse space(D_(P)),the height of the rib neck/head above the lower transverse process(D_(R)),the width of the lateral border of the articular process/lamina(W_(P)),and the width of the posterior border of the vertebral body(W_(V))were measured.At the upper 1/3 of the intervertebral foramina,the horizontal inclination angle(α)from the lateral border of the articular process/lamina to the posterolateral border of the vertebral body was measured.The ratios D_(R)/D_(P) and W_(P)/W_(V) were calculated.The intervertebral foramen parameters were compared between segments.RESULTS No rib head/neck occlusion(D_(R)/D_(P)>0)was found in the intertransverse spaces of T1-2 and T12-L1.The incidence of occlusion for the upper thoracic segments(T1-5,n=138),middle thoracic segments(T5-9,n=116),and lower thoracic segments(T9-L1,n=80)were 76.81%,100%,and 82.50%,respectively.The incidence of occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments(P<0.05).The incidence of>1/2 occlusion(D_(R)/D_(P)>1/2)for the upper,middle,and lower thoracic segments was 7.97%,74.14%,and 32.50%,respectively.The incidence of>1/2 occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments(P<0.05).W_(P) was longer than W_(V) on T1-2 to T9-10 and shorter than W_(V) on T10-11 to T12-L1.The horizontal puncture angle(α)into the external opening of the intervertebral foramina was positively correlated with the segments of the thoracic vertebrae from the cephalic to caudal portion(left:r=0.772,P<0.01;right:r=0.771,P<0.01),and the horizontal inclination angle for T11-12 and T12-L1 was 90°.CONCLUSION It is necessary to identify the spatial impact of the rib head/neck on the puncture path of the intervertebral foramina and design appropriate puncture angles for different segments.
文摘目的:为减小胸椎间孔穿刺时发生气胸、脊髓损伤等并发症的风险,基于CT(computed tomography)影像测量数据,分析不同性别、年龄和体重指数(body mass index,BMI)病人的差异,探究不同节段的变化规律。方法:选取中日友好医院影像数据库中180例成年住院病人胸部CT影像,以T_(2)~T_(12)左侧椎间孔(intervertebral foramen,IF)为穿刺靶点,选取可清楚显示胸椎间孔的CT横断面,模拟椎间孔穿刺操作,测量旁开距离、穿刺角度、穿刺深度和椎间孔至后正中线距离,计算出可行的安全穿刺范围,分析不同性别(男性、女性)、年龄(青年、中年、老年)、BMI(非超重、超重)的测量结果。结果:不同性别的病人相比,男性在各节段的旁开距离和穿刺深度均明显高于女性,在上胸段的穿刺角度低于女性,椎间孔至正中线距离明显大于女性;不同年龄的病人相比,老年病人在T_(2~3)至T_(4~5)节段的最小旁开距离大于青年、中年病人,在T_(3~4)和T_(4~5)节段的穿刺角度小于青年、中年病人;不同BMI病人相比较,超重病人在各节段的旁开距离、穿刺深度均高于非超重病人,在T_(9~10)以上节段的穿刺角度小于非超重病人。从总体规律来看,椎间孔至后正中线距离在T_(5~6)和T_(6~7)最短,旁开距离、穿刺角度、穿刺深度和椎间孔至正中线距离均在中胸段出现极值,向两侧逐渐减小或增大。结论:胸椎穿刺的旁开距离、穿刺角度、穿刺深度由T_(2~3)至T_(11~12)有一定变化规律,各参数在不同性别、年龄、BMI病人之间存在差异,对于临床进行不同节段和人群的椎间孔穿刺操作有一定参考意义。
