经皮椎弓根穿刺辅助装置开发和应用的可行性

摘要

目的：：研制开发经皮椎弓根穿刺辅助定位装置,用带软组织的脊柱标本验证该装置的可行性和实用性。方法：对新鲜保留软组织的脊柱标本行CT扫描,在CT片上的画出理想穿刺线和过棘突的矢状线(棘突线),在距离棘突实际距离为5、10 cm处建立两个冠状位虚拟平面。以棘突线与两平面的交点为原点,过原点的冠状线和垂直线为X轴和Y轴,建立2个平面坐标系,确定穿刺线与这两个平面交点的方位。利用研制的辅助装置,构建体外坐标系,确立穿刺线与平面坐标系交点在辅助装置中的方位,利用这确定的在两个平面坐标系上的交点便可引导穿刺进行。被穿刺椎弓根随机分为2组：一侧采用自行研制的经皮椎弓穿刺辅助装置组(辅助装置组),对侧为“徒手”穿刺组(徒手组)。两组均在C型臂影像增强系统辅助下进行穿刺,置入克氏针,C型臂X线机证实穿刺成功。比较两组的穿刺耗时和X线曝光次数。结果：定位器组和徒手组的穿刺平均耗时分别为(15.36±4.21)min和(27.21±3.89)min,两组比较,差异有统计学意义( P<0.05)；定位器组和徒手组接受X线辅助次数分别为7次/椎体和16次/椎体,两组比较,差异有统计学意义( P<0.05)。结论：应用自行研制的经皮椎弓根穿刺辅助装置可有效减少手术耗时和C臂X线透视次数。%Objective:To develop an auxiliary positioning device for percutaneous vertebral pedicle puncture and to verify the feasibility and practicality of the device by using spine specimens with soft tissues. Methods:Fresh spine specimens with soft tissues were scanned by CT. Ideal puncture line and sagittal line through the spinous process (spinous process line) were drawn on CT images.Two coronal virtual planes,at an actual distance of 5 and 10 cm,respectively,to the spinous process,were established.The intersection of the spinous process line and the two planes was constructed as the origin. Coronary line and perpendicular lines crossing the origin were X-axis and Y-axis,respectively,thereby establishing two plane-coordinate systems.The azimuth of the intersection of the puncture line and the two planes were determined. The in-vitro coordinate system was constructed by the developed auxiliary device.The azimuth of the intersections of the puncture line and the plane-coordinate system in the auxiliary device was determined. The puncture can be guided and performed by using the determined intersections in the two plane-coordinate systems.The punctured vertebral pedicles were randomly divided into two groups where self-developed auxiliary device ( auxiliary device group) or free-hand puncture ( free-hand group) was used for percutaneous vertebral pedicle puncture.Both groups underwent puncture with placement of Kirschner wire under the assistance of a C-type arm image enhancing system. Successful puncture was confirmed by C-type arm X-ray.The elasped time of puncture and X-ray exposures between the two groups were compared.Results:The average elasped time of the puncture in the auxiliary device group and the free-hand group were 15.36±4.21 min vs 27.21±3.89 min,respectively,with statistical difference between the two groups (P<0.05).The number of X-ray exposures in the auxiliary device group and the free-hand group were 7 times / vertebra vs 16 times / vertebra, respectively (P<0.05).Conclusion:The self-developed auxiliary device for percutaneous vertebral pedicle puncture can effectively reduce the duration of puncture and exposures to C-arm X-ray.