| Objective: By studying the morphology of China's adult lumbar spine,we designed the extrapedicular routine for percutaneous vertebroplasty.To figure out the puncture angle and the puncture points.The approach was verified and evaluated by comparing with the transpedicular routine.Methods: Selected dried lumbar vertebra(L1~L5)of 10 old adult cadavers(femal N=5,male N=5,50 in total)from Zhengzhou university anatomy laboratory were involved in this study.Local institutional ethical approval was obtained.The study was made up of three steps: 1)Design the extrapedicular approach by splitting the lumbar through the pedicle section and the isthm of pedicle in the saggital section.Then,we measured the introversion angle ?declination angle.As for the Line of AB ?BD and CP,the data were selected from the axial section of CT scanning by one investigator using a standard technique.2)According to the data above,verified the method on the dried lumbar vertebra.Performancing the percutaneous vertebroplasty for the lumbars and radiographs were obtained on long cassettes by certified radiology technicians in the standardized fashion.3)Transpedicle approach for PVP was set as a control group.The needle to the target point and possibility of penetrating the inner wall of the pedicle were evaluated.Statistical Analyses.All data including imaging studies were statistically analyzed.All analyses were conducted using SPSS statistic software,version 17.0(SPSS Inc,Chicago,IL)and datas were expressed as mean ±standard(SD).T-test and SNK q-test were used.A p value of <0.05 was considered statistically significant.Results:1.5 femal cadavers and 5 male,a total of 50 lumbars were involved in this study.The range of Introversion Angles of L1 was 28.56°~40.10°.L2 was 28.56°~39.30°,L3 was 27.62°~39.80°.L4 was 28.90°~49.00°.L5 was30.10°~57.40 °.There were no significant differences found under male and female contradistinction and comparison among groups using SNK q-test from L1 to L5.2.The range of Obliquity Angles from L1 to L5 was 18.20°~38.50°.There were no significant differences found under male and female contradistinction and comparison among groups using SNK q-test from L1 to L5.3.The length range of osseous track(Line AB)from L1 to L5 was 10.50~27.70 mm.There were no significant differences found under male and female contradistinction and comparison among groups using SNK q-test from L1 to L5.4.The distance from the puncture point on the skin to the spinous process(Line CP)from L1 to L5 was 40.00~105.30 mm.5.The distance from osseous puncture point to the lateral edge of the pedicle(Line BD)of L1 was 6.5~13.5 mm,L2 was 6.9~8.7mm,L3 was 5.7~12.2 mm,L4 was 6.1-10.7 mm,L5 was 7.5~17.0mm.There were no significant differences found under male and female contradistinction and comparison among groups using SNK q-test from L1 to L5 in Line CP and BD.6.As showed in Table 6),in the group of extrapedicular approach,all the needle tips got to the target points.However,on the control group,the possibility of penetrate the inner wall of the pedicle was 4% with a significant differences compared with the extrapedicular approach.Finally,There were no significant differences in gender contradistinction and comparison among groups from L1 to L5 in all parameter,although angles of female was less than the male generally.The Introversion Angles was 37.7°±5.7°,The Obliquity Angles was 24.83°±3.9°,the length of osseous track(Line AB)was 16.24±3.8mm,puncture point on the skin to the spinous process was 75.5±16.4mm,osseous puncture point to the lateral edge of the pedicle was 9.1±2.1mm.Conclusions:Radioanatomical landmarks and introversion angles should be taken into consideration strictly.However,we did not find out the osseous point in the lumbar and just got result that distance from puncture point to the pedicle ring was some 8.5mm. |
PDF Full Text Request