The CT Imaging Analysis And Clinical Application Of Percutaneous Kyphoplasty Of Thoracolumbar Vertebral Body Through Unilateral Approach

objective:Through correlation measurement and analysis of the CT images of thoracolumbar segment(T10-L2),to study the optimal puncture abduction angle and distance from the skin puncture point to the posterior midline of the percutaneous kyphoplasty(PKP)of thoracolumbar vertebral body by unilateral puncture approach,and provide reference for clinical orthopedic surgeons.Methods: Randomly selected 100 non-fractured patients of thoracic and lumbar in our hospital from October 2014 to May 2016(Male 50,female 50 cases)as the research objects.The clinical and imaging data were retrospectively studied.For CT images of the thoracolumbar segments were obtained,we selected the appropriate level in the CT cross-section,in which layer to do vertebral median line,and select the first 1/3 of the line segment,over the point to do perpendicular,the vertical and vertebral body flanked on each side by a node,choose a point and the median line in the front of the vertebral intersection and the median line of the first 1/3 points constitute a triangle,which is the ideal area for the puncture needle.Do the center of gravity of this triangle,which is the representative point of the ideal region,as a single puncture needle at thetarget point to simulate the puncture,puncture track distance from the inner wall of the pedicle is the radius(2 mm)of the sleeve,in this case the angle between the sagittal plane and the puncture trajectory is optimal abduction angle,the best abduction angle of the puncture needle and the distance from the posterior midline to the skin puncture site were measured during the uni-approach PKP operation of the vertebral body from T10 to L2.Gender,age,height and weight of 100 patients were measured and analysed statistically with the optimal abduction angle and the distance to find out if there was any correlation between them.Results: The best abduction angle and the distance between the puncture site and the posterior midline of unilateral approach PKP of thoracolumbar segments of the vertebral body were significantly different(P <0.05).The average abduction angle of unilateral approach PKP in T10 vertebral body was(31.48 ± 0.66)°,and T11(33.19 ± 0.70)°,T12(34.83±0.52)°,L1(36.81±0.67)°,L2(38.22±0.71)°respectively.The mean distance between the puncture point and the posterior median line in the T10 vertebral body was(43.42±2.07)mm,and T11(49.06±2.88)mm,T12(53.70±1.72)mm,L1(58.63±1.88)mm,L2(63.33±2.57)mm respectively.Conclusions:There is a great correlation among the best abduction angle and the distance between the puncture site and the posterior midline of different thoracolumbar segments.The best abduction angles and thedistances between the puncture site and the posterior midline increased from T10 to L2.In the T11,L1 segment,the average abduction angle of the female pations was approximately 1° greater than that of the male,in the T10,T12,L2 segments,the difference between male and female patients was not significant.At each segment from T10 to L2,distance of the male patients had an everage of 3.6 mm more than that of the female patients.The abduction angle and the distance between the puncture site and the posterior midline had no significant correlation with the patient's age,height and weight.The results of this study can provide a reference for clinical orthopedic surgeons in the treatment of osteoporotic vertebral compression fractures of the elderly with unilateral approach PKP.