CAJ | 학술논문

目的通过测量经皮穿刺经椎弓根植骨最佳进针点、角度、深度等相关参数,总结单侧经椎弓根穿刺的规范化方案,为临床手术操作提供依据.方法取10具人体胸腰段(T11～L3)脊柱防腐标本,根据Roy-Camille法,确定进针点和靶点,用3 mm克氏针分别进行穿刺并在X线水平面和矢状面透视下观察,直到穿刺位置满意.在X线照片上测量上倾角、外倾角;取出克氏针测量进针的深度;变换X线照片上的进针点位置后测量最大上倾角和最大下倾角.结果安全穿刺途径的上倾角、外倾角随T11～L3逐渐增大,深度T11～T12逐渐增大,L1～L3逐渐增大,可允许误差的最大下倾角、最大上倾角T11～L3逐渐增大.外倾角的可变动范围极其狭小.结论本试验得到安全穿刺途径的各参数数据,对单侧经椎弓根穿刺椎体成形术的临床操作有指导意义.并发现当椎弓根细小或角度偏小时,单侧经椎弓根穿刺胸腰段椎体成形术对操作的精确度提出了非常高的要求.
목적 통과측량경피천자경추궁근식골최가진침점、각도、심도등상관삼수,총결단측경추궁근천자적규범화방안,위림상수술조작제공의거.방법 취10구인체흉요단(T11～L3)척주방부표본,근거Roy-Camille법,학정진침점화파점,용3 mm극씨침분별진행천자병재X선수평면화시상면투시하관찰,직도천자위치만의.재X선조편상측량상경각、외경각;취출극씨침측량진침적심도;변환X선조편상적진침점위치후측량최대상경각화최대하경각.결과 안전천자도경적상경각、외경각수T11～L3축점증대,심도T11～T12축점증대,L1～L3축점증대,가윤허오차적최대하경각、최대상경각T11～L3축점증대.외경각적가변동범위겁기협소.결론 본시험득도안전천자도경적각삼수수거,대단측경추궁근천자추체성형술적림상조작유지도의의.병발현당추궁근세소혹각도편소시,단측경추궁근천자흉요단추체성형술대조작적정학도제출료비상고적요구.
Objective To measure such operative parameters of unipedicular kyphoplasty as optimal entry point, angle and depth so as to provide rationales for its clinical management and formulate a standardized protocol for unipedicular vertebroplasty. Methods Ten dry thoracolumbar specimens were prepared for measurement. The entry and target points were defined according to the Roy-Camille method. A 3mm Kirschner wire was used to puncture and view in the anteroposterior and lateral aspects of radiography until a satisfying position. The outside oblique and upward oblique angles were measured on the radiographic pictures. After extraction, the depth of Kirschner wire was measured. The positions of entry point were changed and the largest upward oblique angle and largest declination angle measured on the radiographic pictures. Results For safe puncturing, as the outside oblique and upward oblique angles enlarged from T11 to L3, the length enlarged from T11 to T12 and L1 to L3. The accepted error was that the largest upward oblique angle and largest declination angle enlarged from T11 to L3. The alteration range for outside oblique angle was extremely narrow. Conclusion The experimental results provide the guiding data for the operative management of unipedicular thoracolumbar vertebroplasty. ff the pedicle is too small or the angle too narrow,the operative sophistication of vertebroplasty will be highly demanding.