Photoelectric guided navigation unilateral puncture of the percutaneous kyphoplasty in treatment of thoracolumbar osteoporotic vertebral compression fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Xiangyu ^1,2 ,  TAN Lun ¹ , LIN Xu ¹ , WU Chao ¹ , ZENG Jun ¹ , HU Haigang ¹

1. Departmen of Orthopedics, the Fourth People’s Hospital of Zigong, Zigong Sichuan, 643000, P.R.China;
2. Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding?author：

TAN Lun, Email: 1098726536@qq.com

Keywords：

Percutaneous kyphoplasty; osteoporosis vertebral compression fractures; photoelectric navigation; puncture; cement distribution

DOI：

10.7507/1002-1892.201709115

Video：

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ObjectiveTo evaluate the safety of photoelectric guided navigation unilateral puncture of the percutaneous kyphoplasty (PKP) in the treatment of thoracolumbar osteoporotic vertebral compression fracture (OVCF).MethodsA randomized controlled clinical research was performed between June 2015 and January 2017. Eighty-five cases of OVCF were treated with photoelectric guided navigation unilateral puncture of the PKP (trial group, 43 cases) or C arm fluoroscopy unilateral puncture of the PKP (control group, 42 cases) respectively. There was no significant difference in gender, age, disease duration, segmental fracture, AO classification, bone mineral density, and preoperative visual analogue scale (VAS) score between 2 groups (P>0.05). The concordance rate of puncture path and design path, the incidence of pedicle wall breaking, the incidence of bone cement leakage, and the rate of bone cement distribution center were observed and calculated on postoperative CT images; the intraoperative X-ray exposure frequency, frequency of puncture, operation time, VAS scores before operation and at 2 days after operation, and postoperative blood vessel or nerve injury were recorded and compared.ResultsThe intraoperative X-ray exposure frequency and puncture frequency in trial group were significantly less than those in control group (P<0.05), but there was no significant difference in operation time between 2 groups (t=0.440, P=0.661). The VAS scores of 2 groups at 2 days after operation were significantly improved when compared with preoperative ones (P<0.05), but there was no significant difference in VAS score at 2 days after operation between 2 groups (t=0.406, P=0.685). All the patients were followed up 6-18 months (mean, 10 months). No blood vessel or nerve injury occurred in 2 groups. The incidence of pedicle wall breaking, the incidence of bone cement leakage, the concordance rate of puncture path and design path, and the rate of bone cement distribution center in trial group were 2.33% (1/43), 2.33% (1/43), 86.05% (37/43), and 88.37% (38/43) respectively, all showing significant differences when compared with those of control group [19.05% (8/42), 21.43% (9/42), 45.24% (19/42), and 50.00% (21/42) respectively] (P<0.05).ConclusionIntraoperative photoelectric guided navigation unilateral puncture of the PKP can improve the success rate of target puncture and reduce the incidence of pedicle wall breaking effectively, and achieve better bone cement distribution and better security.

Citation： WANG Xiangyu, TAN Lun, LIN Xu, WU Chao, ZENG Jun, HU Haigang. Photoelectric guided navigation unilateral puncture of the percutaneous kyphoplasty in treatment of thoracolumbar osteoporotic vertebral compression fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(2): 203-209. doi: 10.7507/1002-1892.201709115 Copy

1.	Yang H, Liu H, Wang S, et al. Review of percutaneous kyphoplasty in China. Spine (Phila Pa 1976), 2016, 41 Suppl 19: B52-58.
2.	Yimin Y, Zhiwei R, Wei M, et al. Current status of percutaneous vertebroplasty and percutaneous kyphoplasty－a review. Med Sci Monit, 2013, 19: 826-836.
3.	Lamy O, Uebelhart B, Aubry-Rozier B. Risks and benefits of percutaneous vertebroplasty or kyphoplasty in the management of osteoporotic vertebral fractures. Osteoporos Int, 2014, 25(3): 807-819.
4.	劉小勇, 楊惠林, 唐天駟, 等. 椎體后凸成形術棘突定位穿刺點與穿刺軌道的研究. 中華骨科雜志, 2005, 25(8): 462-466.
5.	Wang S, Wang Q, Kang J, et al. An imaging anatomical study on percutaneous kyphoplasty for lumbar via a unilateral transverse process-pedicle approach. Spine (Phila Pa 1976), 2014, 39(9) :701-706.
6.	楊惠林, 王根林, 鄭召民, 等. 椎體后凸成形術中椎管內骨水泥滲漏的探討. 中華創傷骨科雜志, 2008, 10(12): 1105-1107.
7.	陳兵, 沈惠良, 張慶明, 等. PKP 術中發生骨水泥滲漏的危險因素及應對策略. 中國骨與關節損傷雜志, 2011, 26(11): 1026-1027.
8.	鄭召民. 經皮椎體成形術和經皮椎體后凸成形術災難性并發癥——骨水泥滲漏及其預防. 中華醫學雜志, 2006, 86(43): 3027-3030.
9.	羅鵬明, 王新虎, 左春光. PVP 與 PKP 并發癥原因分析及預防. 實用骨科雜志, 2014, 20(5): 398-400.
10.	曹林虎, 譚倫, 林旭, 等. 光電導航系統引導經皮椎弓根螺釘內固定術治療胸腰椎骨折近期療效觀察. 中國修復重建外科雜志, 2016, 30(6): 726-731.
11.	盧小剛. 椎弓根穿刺椎體后凸成形術后穿刺通路的 CT 評價. 瀘州: 西南醫科大學, 2015.
12.	廖旭昱, 周雷杰, 馬維虎, 等. 經皮椎體后凸成形術中單側經椎弓根穿刺角度與骨水泥分布情況的關系. 臨床骨科雜志, 2012, 15(3): 241-244.
13.	Marlin E, Nathoo N, Mendel E. Use of percutaneous kyphoplasty and vertebroplasty in spinal surgery. J Neurosurg Sci, 2012, 56(2): 105-112.
14.	陽春華. 單側與雙側 PKP 治療骨質疏松性胸腰椎壓縮性骨折療效比較. 湖南師范大學學報 (醫學版), 2014, 11(2): 62-64.
15.	申勇, 劉法敬, 張英澤, 等. 單、雙側經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折的療效. 中國脊柱脊髓雜志, 2011, 21(3): 202-206.
16.	朱仰義, 章年年, 任偉峰. 單側與雙側穿刺 PKP 術治療骨質疏松性椎體壓縮性骨折的療效比較. 中華全科醫學, 2014, 12(12): 1941-1944.
17.	Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine (Phila Pa 1976), 2001, 26(14): 1547-1554.
18.	Chen BL, Li YQ, Xie DH, et al. Comparison of unipedicular and bipedicular kyphopbsty on the stiffness and biomechanical balance of compression fractured vertebrae. Ear Spine J, 2011, 20(8): 1272-1280.

1. Yang H, Liu H, Wang S, et al. Review of percutaneous kyphoplasty in China. Spine (Phila Pa 1976), 2016, 41 Suppl 19: B52-58.
2. Yimin Y, Zhiwei R, Wei M, et al. Current status of percutaneous vertebroplasty and percutaneous kyphoplasty－a review. Med Sci Monit, 2013, 19: 826-836.
3. Lamy O, Uebelhart B, Aubry-Rozier B. Risks and benefits of percutaneous vertebroplasty or kyphoplasty in the management of osteoporotic vertebral fractures. Osteoporos Int, 2014, 25(3): 807-819.
4. 劉小勇, 楊惠林, 唐天駟, 等. 椎體后凸成形術棘突定位穿刺點與穿刺軌道的研究. 中華骨科雜志, 2005, 25(8): 462-466.
5. Wang S, Wang Q, Kang J, et al. An imaging anatomical study on percutaneous kyphoplasty for lumbar via a unilateral transverse process-pedicle approach. Spine (Phila Pa 1976), 2014, 39(9) :701-706.
6. 楊惠林, 王根林, 鄭召民, 等. 椎體后凸成形術中椎管內骨水泥滲漏的探討. 中華創傷骨科雜志, 2008, 10(12): 1105-1107.
7. 陳兵, 沈惠良, 張慶明, 等. PKP 術中發生骨水泥滲漏的危險因素及應對策略. 中國骨與關節損傷雜志, 2011, 26(11): 1026-1027.
8. 鄭召民. 經皮椎體成形術和經皮椎體后凸成形術災難性并發癥——骨水泥滲漏及其預防. 中華醫學雜志, 2006, 86(43): 3027-3030.
9. 羅鵬明, 王新虎, 左春光. PVP 與 PKP 并發癥原因分析及預防. 實用骨科雜志, 2014, 20(5): 398-400.
10. 曹林虎, 譚倫, 林旭, 等. 光電導航系統引導經皮椎弓根螺釘內固定術治療胸腰椎骨折近期療效觀察. 中國修復重建外科雜志, 2016, 30(6): 726-731.
11. 盧小剛. 椎弓根穿刺椎體后凸成形術后穿刺通路的 CT 評價. 瀘州: 西南醫科大學, 2015.
12. 廖旭昱, 周雷杰, 馬維虎, 等. 經皮椎體后凸成形術中單側經椎弓根穿刺角度與骨水泥分布情況的關系. 臨床骨科雜志, 2012, 15(3): 241-244.
13. Marlin E, Nathoo N, Mendel E. Use of percutaneous kyphoplasty and vertebroplasty in spinal surgery. J Neurosurg Sci, 2012, 56(2): 105-112.
14. 陽春華. 單側與雙側 PKP 治療骨質疏松性胸腰椎壓縮性骨折療效比較. 湖南師范大學學報 (醫學版), 2014, 11(2): 62-64.
15. 申勇, 劉法敬, 張英澤, 等. 單、雙側經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折的療效. 中國脊柱脊髓雜志, 2011, 21(3): 202-206.
16. 朱仰義, 章年年, 任偉峰. 單側與雙側穿刺 PKP 術治療骨質疏松性椎體壓縮性骨折的療效比較. 中華全科醫學, 2014, 12(12): 1941-1944.
17. Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine (Phila Pa 1976), 2001, 26(14): 1547-1554.
18. Chen BL, Li YQ, Xie DH, et al. Comparison of unipedicular and bipedicular kyphopbsty on the stiffness and biomechanical balance of compression fractured vertebrae. Ear Spine J, 2011, 20(8): 1272-1280.

Chinese Journal of Reparative and Reconstructive Surgery

Photoelectric guided navigation unilateral puncture of the percutaneous kyphoplasty in treatment of thoracolumbar osteoporotic vertebral compression fracture

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