经横突-椎弓根入路单侧经皮椎体后凸成形术的解剖学差异的年龄、性别、水平和侧位差异。

Age, Gender, Level and Side Differences in the Anatomical Distinctions of Unilateral Percutaneous Kyphoplasty through the Transverse Process-Pedicle Approach.

机构信息

Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning, China; State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning, China; State Key Laboratory of Materials Processing and Die & Mould Technology, Huazhong University of Science and Technology, Wuhan, Hubei, China; State Key Laboratory of Trauma, Burn and Combined Injury, Third Military Medical University, Chongqing, China.

Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning, China; Graduate School, Dalian Medical University, Dalian, Liaoning, China.

出版信息

Pain Physician. 2019 Mar;22(2):E91-E96.

PMID:30921985

Abstract

BACKGROUND

Unilateral and bilateral percutaneous kyphoplasty (PKP) have been widely adopted to treat osteoporotic vertebral compression fractures (OVCFs). Unilateral PKP has a shorter operation time and less radiation exposure time compared with bilateral PKP, but the anatomical distinctions of unilateral PKP are not identical in all cases.

OBJECTIVE

The aim of this study was to examine the significance of age, gender, level, and side in relation to the anatomical distinctions of unilateral PKP for lumbar OVCFs through the transverse process-pedicle approach (TPPA).

STUDY DESIGN

This was a retrospective study of 200 patients.

SETTING

The research took place at General Hospital of Shenyang Military Area Command of Chinese PLA.

METHODS

Researchers examined 1000 lumbar spines (L1-L5) of 200 patients and simulated PKP on the 3D-CT scans through unilateral TPPA. The distance between the entry point and the midline of the vertebral body (DEM), the puncture inclination angle (PIA), the safe range of the inner inclination angles (SRA), and the success rate (SR) of puncture were measured and compared.

RESULTS

There were significant differences (P < 0.05) in the mean DEM between men and women, and between the left and right sides. The DEM was significantly larger in men than women and in right than left. The DEM from L1 to L5 was significantly increased (P < 0.05), from 22.4 ± 2.0 mm to 34.1 ± 4.3 mm. The right maximum PIA was significantly larger than the left. The maximum puncture angle and SRA in men was larger than that in women except for L5. The SRA from L1 to L5 was significantly increased (P < 0.05), from 20.1 ± 6.0 mm to 44.2 ± 8.8 mm. The SR from L1 to L5 was significantly increased (P < 0.05), from 88.3% to 100%. The SR in men was significantly higher than that in women for L1 and L2.

LIMITATIONS

Sample size was relatively small.

CONCLUSIONS

The DEM was 22.4 mm to 34.1 mm according to different levels. There were significant gender, side, and age differences in the DEM and PIA. The values of DEM, PIA, SRA and SR were significantly increased from L1 to L5.

KEY WORDS

Lumbar, osteoporotic vertebral compression fracture, unilateral, percutaneous kyphoplasty, transverse process.

摘要

背景

单侧和双侧经皮椎体后凸成形术（PKP）已广泛用于治疗骨质疏松性椎体压缩性骨折（OVCFs）。与双侧 PKP 相比，单侧 PKP 具有更短的手术时间和更少的放射暴露时间，但并非所有情况下单侧 PKP 的解剖差异都相同。

目的

本研究旨在通过经横突-椎弓根入路（TPPA）探讨年龄、性别、水平和侧别与腰椎 OVCF 单侧 PKP 解剖差异的关系。

研究设计

这是一项回顾性研究，共纳入 200 例患者。

研究地点

中国人民解放军沈阳军区总医院。

研究方法

研究人员对 200 例患者的 1000 个腰椎（L1-L5）进行了检查，并通过单侧 TPPA 在 3D-CT 扫描上模拟 PKP。测量并比较了入点与椎体中线的距离（DEM）、穿刺倾斜角（PIA）、内倾斜角安全范围（SRA）和穿刺成功率（SR）。

结果

男性与女性、左右两侧之间的平均 DEM 存在显著差异（P < 0.05）。男性的 DEM 明显大于女性，右侧的 DEM 明显大于左侧。从 L1 到 L5，DEM 显著增加（P < 0.05），从 22.4 ± 2.0 mm 增加到 34.1 ± 4.3 mm。右侧最大 PIA 明显大于左侧。男性的最大穿刺角度和 SRA 除 L5 外均大于女性。从 L1 到 L5，SRA 显著增加（P < 0.05），从 20.1 ± 6.0 mm 增加到 44.2 ± 8.8 mm。从 L1 到 L5，SR 显著增加（P < 0.05），从 88.3%增加到 100%。男性的 SR 在 L1 和 L2 明显高于女性。