Parameter Measurement And Analysis Of Two Punctcure Trajetories For Percutaneous Kyphoplasty In Lumbar Spine

Objective:Two kinds of puncture track were simulated on three-dimensional CT image of lumbar spine.Measure the distribution parameters of two kinds of puncture trajectories in the lumbar vertebral body and analyze its clinical significance.Methods:From January 2016 to May 2018,200 patients,including 200 L1-L5 vertebrae and 200 L1-L5 vertebrae,who underwent lumbar CT examination in the outpatient and inpatient departments of orthopaedics of the First Affiliated Hospital of Suzhou University and whose image data could be reconstructed on Neusoft image diagnostic workstation,were enrolled in the study.The patient’s lumbar spine CT image was reconstructed in three dimensions in the Neusoft imaging diagnostic workstation,a cross section image of the vertebral body was taken from the central point of the pedicle to the plane connecting the middle and lower 1/3 of the anterior edge of the vertebral body and puncture was performed on the cross-sectional image to simulate percutaneous kyphoplasty.Conventional needling points and transverse process-pedicle needling points were selected for osseous needling points.The puncture path passed through the central point of pedicle isthmus,and the puncture line was simulated to pass forward to 1/3 of the anterior and middle vertebral body.The distance between the needle tip and the midline of the vertebral body and the distance between the needle tip and the edge of the vertebral body were recorded and tatistically.SPSS 19.0 was used to analyze the data.Results:There was no significant difference in the ratio of the distance from the conventional needling point to the midline and the radius of the vertebral body(P>0.05).The distribution parameters of the same puncture track at different segments of the lumbar spine and the two puncture tracks at the same segment in the vertebral body were statistically different(P<0.01).The ratio of the midline to the transverse diameter of the vertebral body increased gradually from L1 to L5 when the puncture needle reached the anterior and middle 1/3 of the vertebral body through the conventional pedicle approach.Among them,the needle tips of L1 to L4 were 1/3 in the middle of the hemicentrum.,and the needle tips of L5 were 1/3 outside the hemicentrum.When the transverse process-pedicle approach puncture needle reached 1/3 of the anterior and middle vertebral body,the needle tips of L1 to L4 were 1/3 of the inner hemicentrum,and the needle tips of L5 were 1/3 of the middle hemicentrum.Routine conventional approach,when the puncture recommended,and bilateral transverse root puncture is recommended for L5 vertebra,the puncture needle reaches 1/3 of the anterior and middle vertebral body,it can not reach the middle line or the opposite side in L1 to L5;and the transverse process-pedicle approach,When the puncture needle reached 1/3 of the anterior and middle vertebral body,the proportion of L1 to L4 reaching or exceeding the midline of the vertebral body was 47%,70%,68%and 50%,L5 could not reach the midline or the opposite side.Conclusion:When percutaneous kyphoplasty is performed on the lumbar spine,in the L1-L4 vertebra,bilateral puncture through conventional approach or unilateral puncture through the transverse process-pedicle approach is recommended.Bilateral puncture through the transverse process-pedicle approach is recommended in the L5 vertebra.