摘要
目前经皮穿刺椎体成形术(PVP)/经皮穿刺后凸成形术(PKP)的穿刺路径包括经椎弓根单侧入路、双侧入路、椎弓根外入路三大类。本文概括了14种临床上常见的PVP/PKP穿刺入路方式或穿刺技术,包括其使用条件、最佳适用指征和技术风险等。近年来椎弓根外入路穿刺技术应用逐渐广泛。采用椎弓根外入路穿刺技术的PVP/PKP手术在手术时间、手术创伤、医患放射暴露剂量、耗材费用方面均低于传统经椎弓根双侧入路手术,并能摆脱传统经椎弓根单侧入路穿刺时椎弓根外壁对穿刺外展角的限制,使穿刺针外展角度增大,更有利于穿刺针尖端到达中线附近,实现骨水泥沿中线附近对称弥散。在胸椎及腰椎上段,由于存在脊髓损伤风险,穿刺可优先考虑椎弓根外入路。而腰椎下段由于单侧椎弓根外入路穿刺存在损伤腰动脉风险,推荐使用经椎弓根单侧入路。术前穿刺路径规划需根据操作者技术优势,并结合患者伤椎形态差异与关键参数等选择合适的手术方式。
At present,the puncture approaches for percutaneous vertebroplasty(PVP)/penetrating keratoplasty(PKP)include unilateral pedicular approach,bilateral pedicular approach,and extrapedicular approach.This article summarizes 14 puncture approaches for PVP/PKP that are commonly used in clinical practice,including application conditions,optimalindications,and technical risks.In recent years,the extrapedicular approach has gained increasing popularity.Compared to traditional bilateral transpedicular techniques,the extrapedicular approach demonstrates advantages in reducing operative time,minimizing tissue trauma,lowering radiation exposure,and decreasing material costs.Importantly,it overcomes the anatomical limitation of the lateral pedicle wall on needle angulation in unilateral transpedicular puncture,allowing greater lateral inclination to position the needle tip near the vertebral midline,thereby facilitating symmetrical cement diffusion along the central axis.For thoracic and upper lumbar vertebrae,the extrapedicular approach is prioritized to mitigate the risk of spinal cord injury.Conversely,in the lower lumbar region,the unilateral transpedicular approach is recommended to avoid potential lumbar artery damage associated with extrapedicular puncture.The puncture path should be determined before surgery based on the technical advantages of the operator,and an appropriate surgical procedure should be selected based on the morphology of the fractured vertebra and related key parameters.
作者
王鹏
王璐璐
WANG Peng;WANG Lulu(Department of Spine Surgery,Shengli Oilfield Central Hospital,Dongying 257000,China)
出处
《精准医学杂志》
2026年第1期87-91,共5页
Journal of Precision Medicine
关键词
椎体后凸成形术
椎体成形术
穿刺术
穿刺入路
骨黏合剂
诊断和治疗物质外渗
综述
Kyphoplasty
Vertebroplasty
Punctures
Puncture approach
Bone cements
Extravasation of diagnostic and therapeutic materials
Review
