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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 of lumbar percutaneous vertebroplasty by transpedicular-pedicle approach and investigate the feasibility and safety of vertebroplasty in this approach. Methods A total of 300 lumbar vertebrae from 60 patients were randomly selected. The X-ray images and CT images were used to simulate the unilateral pedicle approach (control group) and unilateral transaxial-pedicle approach Study group) to complete percutaneous vertebroplasty 600 times. The distance between the puncture point and the midline of the vertebral body on the left and right sides of each vertebra of L_1 ~ L_5 and the two approaches of L_1 ~ L_5 in the same surgical approach were measured and compared. Puncture angle safety range and puncture success rate. Results The distance from the center of L_1 to L_5 vertebral body to the midline of both groups increased gradually, and the distance to the right of L_1 and L_2 in the control group was significantly greater than that of the left. In the study group, the distance to the right of L_1, L_2 and L_5 was significantly greater than that of the left P <0.05). The distance from the puncture site to the midline of L_1 ~ L_5 vertebral body in the study group was significantly larger than that in the control group (P <0.05). The maximum outer declination angle, middle declination angle and minimum declination angle of L_1, L_2, L_4 and L_5 in L_1 ~ L_5 group were significantly larger than those in the left (P <0.05). L_1 ~ L_5 left and right side of the maximum angle of decoupling, midpoint declination angle gradually increased, the minimum angle of declination was not obvious, but all the declination angle were significantly greater than the control group (P <0.05). There was no significant difference in the safety range of puncture angles between L_1 and L_5 in both groups (P> 0.05). The safe range of puncture angle of L_5 in study group was significantly smaller than that in control group (P <0.05). The success rate of L_1 ~ L_4 puncture in study group was significantly higher than that in control group (P <0.05), L_5 The successful rate of puncture was no significant difference between the two groups (P> 0.05). Conclusions The puncture point of unilateral transverse trans-pedicle approach is more eccentric than the traditional transpedicular approach, and the puncture angle is larger and the puncture assembly rate is higher. Unilateral transthoracic-pedicle approach is a more secure and reliable approach to trans-pedicle than traditional pedicle approach.