透视引导下犬椎体成形术穿刺模型建立和评价
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海军军医大学第二附属医院

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上海市2020年度“科技创新行动计划”实验动物研究领域项目,基金编号201409003700


Establishment and Evaluation of a Canine Vertebral Augmentation Puncture Model under Fluoroscopic Guidance
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The Second Affiliated Hospital of Naval Medical University

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Shanghai 2020 annual "science and technology innovation action plan" laboratory animal research projects,201409003700

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    摘要:

    目的:通过对犬脊柱解剖形态的测量及分析,建立透视下犬椎体成形术穿刺模型,并通过术后影像学分析,评估该模型建立方法的有效性和安全性。方法:测量6只12月龄左右犬腰椎标本形态及其参数:L1~L7椎体高度、椎体基底宽度、椎间盘上缘距椎体最狭部距离、脊椎乳突垂直线距椎间盘上缘距离、横突中点与椎间盘下缘垂直距离,以明确犬椎体解剖特点,确定骨水泥注射的最佳位置、注射方向以及注射深度后,对6只健康比格犬(体重20—25kg)L4、L5、L6椎体建立椎体成形术用穿刺模型。术后4周处死后行影像学检查,主要观测指标包括:手术时间,术后植入骨水泥分布,椎管及椎体前缘完整性。结果:通过犬解剖观测,椎体高度从L1~L5逐渐增大,从L5~L7逐渐减小,椎体基底部宽度从L1~L7逐渐增大。脊椎乳突垂直线距椎间盘上缘距离呈L1~L7逐渐增加趋势(1.9~4.0mm)。横突根部中点和椎间盘下缘的距离由L1~L5逐渐增加(4.7~6.9mm), L4、L5、L6节段每只犬横突根部中点和椎间盘下缘的距离之间(P=0.925)无明显统计学差异。以脊椎横突根部中点为穿刺点,置入方向和水平面呈20°~30°角,头倾方向5°~15°,穿刺深度1.2cm~1.5cm。若向椎体尾侧穿刺,穿刺针尾的倾角度为30°~35°,进针深度为1.5cm~1.8cm。可以构建犬椎体穿刺手术模型。共成功制作15个犬椎体穿刺手术模型,单节段平均手术时间22.7±4.6min(15~30min)。术中1个椎体节段出现脊髓损伤导致下肢瘫痪、大小便失禁等症状,2个椎体骨皮质破裂,未出现麻醉或感染导致死亡。术后4周的Micro—CT三维重建均显示骨水泥在犬椎体松质骨内分布,新生骨组织包裹植入材料,无渗漏,无椎管及椎体前壁破损等并发症。结论:在犬4~6腰椎解剖基础上,以横突根部中点为骨性标志,可以成功建立一种安全可靠的犬椎体成形术用穿刺模型。

    Abstract:

    Objective: To establish a fluoroscopic percutaneous vertebral augmentation model in dogs through measurement and analysis of canine spinal anatomy. Furthermore, the effectiveness and safety of this modeling method are assessed through post-operative radiological analysis. Methods: Morphological measurements and their parameters of the lumbar vertebrae of six dogs aged around 12 months were taken: height of the L1-L7 vertebrae, width of the vertebral base, distance from the upper edge of the intervertebral disc to the narrowest part of the vertebra, distance from the vertical line of the spinous process to the upper edge of the intervertebral disc, and the vertical distance from the midpoint of the transverse process to the lower edge of the intervertebral disc. This was done to clarify the anatomical characteristics of the canine vertebrae and to determine the optimal location, direction, and depth for bone cement injection. Subsequently, a percutaneous vertebral augmentation model was established in the L4, L5, and L6 vertebrae of six healthy Beagle dogs weighing between 20-25kg. Four weeks post-surgery, the subjects were euthanized and radiologically examined. Primary observations included: surgical duration, post-operative distribution of the implanted bone cement, and the integrity of the vertebral canal and anterior edge of the vertebrae. Results: Anatomical observation of the canine vertebrae revealed that the vertebral height gradually increased from L1 to L5 and then decreased from L5 to L7. The width of the vertebral base consistently increased from L1 to L7. The distance from the vertical line of the spinous process to the upper edge of the intervertebral disc showed an increasing trend from L1 to L7 (1.9 to 4.0 mm). The distance between the midpoint of the base of the transverse process and the lower edge of the intervertebral disc gradually increased from L1 to L5 (4.7 to 6.9 mm). There was no significant statistical difference in the distance between the midpoint of the base of the transverse process and the lower edge of the intervertebral disc in the L4, L5, and L6 segments among the dogs (P=0.925). The midpoint of the root of the transverse process of the spine was taken as the puncture point, and the insertion direction and horizontal plane were at an Angle of 20° - 30 °, with a head tilt of 5° - 15° and a puncture depth of 1.2 cm to 1.5 cm. If the puncture was directed towards the caudal side of the vertebra, the angle of the needle tail was 30° to 35°, with a penetration depth of 1.5 cm to 1.8 cm. This technique allowed for the successful construction of a canine vertebral puncture surgical model. A total of 15 canine vertebral puncture surgical models were successfully created, with an average surgery time of 22.7 ± 4.6 minutes (ranging from 15 to 30 minutes) per vertebral segment. During surgery, one vertebral segment experienced spinal cord injury resulting in paralysis of the hind limbs and incontinence of both bowel and bladder. Two vertebral cortical bones fractured, but there were no deaths due to anesthesia or infection. Four weeks post-surgery, Micro-CT three-dimensional reconstructions consistently showed bone cement distributed within the trabecular bone of the canine vertebrae, with newly formed bone tissue enveloping the implanted material. There was no leakage, and no complications such as damage to the vertebral canal or the anterior wall of the vertebrae were observed. Conclusions: Based on the anatomy of the canine lumbar vertebrae (L4 to L6), using the midpoint of the base of the transverse process as a bony landmark, a safe and reliable canine vertebral augmentation puncture model can be successfully established.

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  • 收稿日期:2023-12-19
  • 最后修改日期:2024-02-19
  • 录用日期:2024-03-27
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