基于CT影像数据测量的胸椎间孔穿刺的可及性和安全性研究*

A study of the accessibility and safety in intervertebral foramen puncture based on CT image measurement

摘要:

摘要 目的：为减小胸椎间孔穿刺时发生气胸、脊髓损伤等并发症的风险，基于CT影像测量数据，分析不同性别、年龄和BMI患者的差异，探究不同节段的变化规律。方法：选取中日友好医院影像数据库中180例成年住院患者胸部CT影像，以T2-T12左侧椎间孔为穿刺靶点，选取可清楚显示胸椎间孔的CT横断面，模拟椎间孔穿刺操作，测量旁开距离、穿刺角度、穿刺深度和椎间孔至后正中线距离，得到可行的安全穿刺范围，分析不同性别（男性、女性）、年龄（青年、中年、老年）、BMI（非超重、超重）的测量结果。所得数据用均值±标准差（x±SD）表示，采用SPSS 26.0 统计软件进行分析，组间比较采用单因素方差分析，以P<0.05为差异有统计学意义。结果：男性患者在所有节段的旁开距离和穿刺深度均明显高于女性（P＜0.01）,女性患者的穿刺角度在上胸段高于男性（P＜0.05），老年患者在T2-3～T4-5节段的最小旁开距离大于青、中年患者（P＜0.05），在T3-4和T4-5节段的穿刺角度小于青、中年患者（P＜0.05），超重患者所有节段的旁开距离、穿刺深度均高于非超重患者（P＜0.01），在T9-10以上节段的穿刺角度小于非超重患者（P＜0.01）。椎间孔至后正中线距离在T5-6、T6-7最短，男性患者的椎间孔至正中线距离明显大于女性。旁开距离、穿刺角度、穿刺深度和椎间孔至正中线距离均在中胸段出现极值，向两侧逐渐减小或增大。结论：胸椎穿刺的旁开距离、穿刺角度、穿刺深度由T2-3至T11-12有一定变化规律，各参数在不同性别、年龄、BMI患者之间存在差异，对于临床进行不同节段和人群的椎间孔穿刺操作有一定参考意义。

Abstract:

Subjective: To reduce the risk of complications such as pneumothorax and spinal cord injury during thoracic intervertebral foramen puncture, based on CT image measurement, the differences of different genders, ages, and BMI patients were analyzed, and the overall change law of different segments were explored. Methods: 180 adult inpatient chest CT images from the China-Japan Friendship Hospital image database were selected, with the left T2-T12 intervertebral foramen(IF) as the puncture target. CT cross-sectional images that clearly showed the IF were selected, and the puncture operation was simulated. The side distance, angle of needle insertion, depth of needle insertion, and distance from the IF to the posterior median line were measured and analyzed for different genders (male and female), ages (youth, middle age, and old age), and BMI (non-overweight and overweight). The CT images measurement values were expressed as mean ± standard deviation (x ± SD) and analyzed using SPSS 26.0 statistic software. Intergroup comparisons were made using one-way ANOVA analysis, and P <0.05 was considered statistically significant. Results: The side distance and depth of needle insertion of male patients were significantly higher than those of female patients in all thoracic segments (P < 0.01), and the angle of needle insertion of female patients was higher than those of male patients in the upper thoracic segment (P < 0.05). The minimum side distance of old patients in T2-3～T4-5 segments was higher than those of youth and middle age patients (P < 0.05), and the angle of needle insertion in T3-4 and T4-5 segments was smaller than those of youth and middle-aged patients (P < 0.05). The side distance, depth, and angle of needle insertion of overweight patients were higher than those of non-overweight patients in all thoracic segments (P < 0.01), and the angle of needle insertion in T9-10 segment and above was smaller than those of non-overweight patients (P < 0.01). The distance from IF to the posterior median line was the shortest in T5-6 and T6-7, and the distance from the IF to the posterior median line of male patients was significantly higher than that of female patients. The side distance, angle and depth of needle insertion, and distance from the IF to the posterior median line reached a maximum in the middle thoracic segments and gradually decreased or increased to both sides. Conclusion: The side distance, angle, and depth of needle insertion, and distance from the IF to the posterior median line have specific change laws from T2-3 to T11-12, and there are statistical differences in CT image measurement values among different gender, age, and BMI patients, This has particular reference value for the clinical operation of different segments and populations.