Robot-guided percutaneous kyphoplasty in treatment of multi-segmental osteoporotic vertebral compression fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIN Shu , HU Jiang , WAN Lun ,  TANG Liuyi , WANG Yue , YU Yang , ZHANG Wei

Department of Orthopedics, Sichuan Academy of Medical Science, People’s Hospital of Sichuan Province, Chengdu Sichuan, 610072, P.R.China;

Corresponding?author：

TANG Liuyi, Email: 18981838527@189.cn

Keywords：

Robot; percutaneous kyphoplasty; osteoporotic vertebral compression fracture; thoracolumbar spine

DOI：

10.7507/1002-1892.202002131

Video：

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Objective To evaluate the safety and effectiveness of robot-guided percutaneous kyphoplasty (PKP) in treatment of multi-segmental thoracolumbar osteoporotic vertebral compression fracture (OVCF).Methods A clinical data of 63 cases with multi-segmental thoracolumbar OVCF without neurologic deficit treated with PKP between October 2017 and February 2019 were analyzed retrospectively. The patients were divided into robot-guided group (33 cases) and traditional fluoroscopy group (30 cases). There was no significant difference in gender, age, fracture segment, bone mineral density, and preoperative visual analogue scale (VAS) score, midline vertebral height, and Cobb angle between the two groups (P>0.05). The time to establish the tunnel, the times of fluoroscopy, the dose of fluoroscopy, the deviation of puncture, the distribution of bone cement, the leakage of bone cement, the puncture angle, and the postoperative VAS score, midline vertebral height, and Cobb angle were recorded and compared.Results The patients in two groups were followed up 11-13 months (mean, 12 months). Compared with traditional fluoroscopy group, the time to establish the tunnel, the times and dose of fluoroscopy in robot-guided group were significantly lower, the deviation of puncture was slighter, the distribution of bone cement was better, and the puncture angle was larger, the differences between the two groups were significant (P<0.05). There were 8 segments (9.3%, 8/86) of bone leakage in robot-guided group and 17 segments (22.6%, 17/75) in traditional fluoroscopy group, the difference between the two groups was significant (χ²=5.455, P=0.020). There was no significant difference in VAS score, the midline vertebral height, and Cobb angle between the two groups at 2 days after operation and last follow-up (P>0.05).Conclusion Robot-guided PKP in treatment of multi-segmental thoracolumbar OVCF can shorten the operation time, improve the accuracy of puncture, reduce the times and dose of fluoroscopy, reduce the leakage of bone cement, and achieve better cement distribution.

Citation： LIN Shu, HU Jiang, WAN Lun, TANG Liuyi, WANG Yue, YU Yang, ZHANG Wei. Robot-guided percutaneous kyphoplasty in treatment of multi-segmental osteoporotic vertebral compression fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(9): 1136-1141. doi: 10.7507/1002-1892.202002131 Copy

1.	劉博, 谷元, 王鵬, 等. 椎體后凸成形術治療 580 例老年性骨質疏松性椎體壓縮性骨折療效的影響因素分析. 中國骨質疏松雜志, 2019, 25(10): 1469-1473.
2.	Yang H, Liu H, Wang S, et al. Review of percutaneous kyphoplasty in China. Spine (Phila Pa 1976), 2016, 41(Suppl 19): B52-B58.
3.	任志偉, 尹思, 王瑩, 等. 經皮椎體后凸成形術治療多節段骨質疏松性椎體壓縮性骨折的療效分析. 實用骨科雜志, 2018, 24(7): 633-637.
4.	Ye LQ, Liang D, Jiang XB, et al. Risk factors for the occurrence of insufficient cement distribution in the fractured area after percutaneous vertebroplasty in osteoporotic vertebral compression fractures. Pain Physician, 2018, 21(1): E33-E42.
5.	Zhou X, Meng X, Zhu H, et al. Early versus late percutaneous kyphoplasty for treating osteoporotic vertebral compression fracture: a retrospective study. Clin Neurol Neurosurg, 2019, 180: 101-105.
6.	王翔宇, 譚倫, 林旭, 等. 光電導航引導單側穿刺椎體后凸成形術治療胸腰椎骨質疏松性椎體壓縮骨折. 中國修復重建外科雜志, 2018, 32(2): 203-209.
7.	Gao C, Zong M, Wang WT, et al. Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Acta Radiol, 2018, 59(5): 577-585.
8.	Yang JS, He B, Tian F, et al. Accuracy of robot-assisted percutaneous pedicle screw placement for treatment of lumbar spondylolisthesis: a comparative cohort study. Med Sci Monit, 2019, 25: 2479-2487.
9.	楊俊松, 郝定均, 劉團江, 等. 脊柱機器人與透視輔助下經皮植釘治療腰椎滑脫癥中植釘精度的對比研究. 中國修復重建外科雜志, 2018, 32(11): 1371-1376.
10.	徐鵬, 葛鵬, 章仁杰, 等. 機器人輔助下椎弓根螺釘固定治療胸腰椎骨折. 頸腰痛雜志, 2018, 39(6): 687-690.
11.	Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
12.	李凡杰, 杜怡斌, 劉藝明, 等. 椎體成形與彎角椎體成形治療骨質疏松性椎體壓縮骨折: 骨水泥注射后分布與滲漏率的比較. 中國組織工程研究, 2020, 24(10): 1484-1490.
13.	張在田, 張緒華, 衛志華, 等. 機器人輔助與徒手單側穿刺椎體成形術治療骨質疏松性椎體壓縮骨折療效的比較. 骨科臨床與研究雜志, 2018, 3(4): 205-208.
14.	田野, 張嘉男, 陳浩, 等. 脊柱機器人與傳統透視輔助下微創經皮復位內固定術治療單節段無神經癥狀胸腰椎骨折對比研究. 中國修復重建外科雜志, 2020, 34(1): 69-75.
15.	林書, 胡豇, 萬侖, 等. 機器人輔助下經皮微創椎弓根螺釘內固定與傳統開放內固定治療胸腰椎骨折的短期療效比較. 中國修復重建外科雜志, 2020, 34(1): 76-82.
16.	Laudato PA, Pierzchala K, Schizas C. Pedicle screw insertion accuracy using O-Arm, robotic guidance or freehand technique: a comparative study. Spine (Phila Pa 1976), 2018, 43(6): E373-E378.
17.	Feng S, Tian W, Sun Y, et al. Effect of robot-assisted surgery on lumbar pedicle screw internal fixation in patients with osteoporosis. World Neurosurg, 2019, 125: e1057-e1062.
18.	Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine, 2019, 8: 1-8.
19.	Zhang Q, Xu YF, Tian W, et al. Comparison of superior-level facet joint violations between robot-assisted percutaneous pedicle screw placement and conventional open fluoroscopic-guided pedicle screw placement. Orthop Surg, 2019, 11(5): 850-856.
20.	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.
21.	李浩, 方宣城, 邱新建, 等. 機器人輔助與 “C” 型臂 X 線機透視經皮微創椎弓根螺釘內固定治療胸腰椎骨折療效的比較. 骨科臨床與研究雜志, 2018, 3(4): 200-204.
22.	Hyun SJ, Kim KJ, Jahng TA, et al. Minimally invasive robotic versus open fluoroscopic-guided spinal instrumented fusions: a randomized controlled trial. Spine (Phila Pa 1976), 2017, 42(6): 353-358.
23.	Kantelhardt SR, Martinez R, Baerwinkel S, et al. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J, 2011, 20(6): 860-868.

1. 劉博, 谷元, 王鵬, 等. 椎體后凸成形術治療 580 例老年性骨質疏松性椎體壓縮性骨折療效的影響因素分析. 中國骨質疏松雜志, 2019, 25(10): 1469-1473.
2. Yang H, Liu H, Wang S, et al. Review of percutaneous kyphoplasty in China. Spine (Phila Pa 1976), 2016, 41(Suppl 19): B52-B58.
3. 任志偉, 尹思, 王瑩, 等. 經皮椎體后凸成形術治療多節段骨質疏松性椎體壓縮性骨折的療效分析. 實用骨科雜志, 2018, 24(7): 633-637.
4. Ye LQ, Liang D, Jiang XB, et al. Risk factors for the occurrence of insufficient cement distribution in the fractured area after percutaneous vertebroplasty in osteoporotic vertebral compression fractures. Pain Physician, 2018, 21(1): E33-E42.
5. Zhou X, Meng X, Zhu H, et al. Early versus late percutaneous kyphoplasty for treating osteoporotic vertebral compression fracture: a retrospective study. Clin Neurol Neurosurg, 2019, 180: 101-105.
6. 王翔宇, 譚倫, 林旭, 等. 光電導航引導單側穿刺椎體后凸成形術治療胸腰椎骨質疏松性椎體壓縮骨折. 中國修復重建外科雜志, 2018, 32(2): 203-209.
7. Gao C, Zong M, Wang WT, et al. Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Acta Radiol, 2018, 59(5): 577-585.
8. Yang JS, He B, Tian F, et al. Accuracy of robot-assisted percutaneous pedicle screw placement for treatment of lumbar spondylolisthesis: a comparative cohort study. Med Sci Monit, 2019, 25: 2479-2487.
9. 楊俊松, 郝定均, 劉團江, 等. 脊柱機器人與透視輔助下經皮植釘治療腰椎滑脫癥中植釘精度的對比研究. 中國修復重建外科雜志, 2018, 32(11): 1371-1376.
10. 徐鵬, 葛鵬, 章仁杰, 等. 機器人輔助下椎弓根螺釘固定治療胸腰椎骨折. 頸腰痛雜志, 2018, 39(6): 687-690.
11. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
12. 李凡杰, 杜怡斌, 劉藝明, 等. 椎體成形與彎角椎體成形治療骨質疏松性椎體壓縮骨折: 骨水泥注射后分布與滲漏率的比較. 中國組織工程研究, 2020, 24(10): 1484-1490.
13. 張在田, 張緒華, 衛志華, 等. 機器人輔助與徒手單側穿刺椎體成形術治療骨質疏松性椎體壓縮骨折療效的比較. 骨科臨床與研究雜志, 2018, 3(4): 205-208.
14. 田野, 張嘉男, 陳浩, 等. 脊柱機器人與傳統透視輔助下微創經皮復位內固定術治療單節段無神經癥狀胸腰椎骨折對比研究. 中國修復重建外科雜志, 2020, 34(1): 69-75.
15. 林書, 胡豇, 萬侖, 等. 機器人輔助下經皮微創椎弓根螺釘內固定與傳統開放內固定治療胸腰椎骨折的短期療效比較. 中國修復重建外科雜志, 2020, 34(1): 76-82.
16. Laudato PA, Pierzchala K, Schizas C. Pedicle screw insertion accuracy using O-Arm, robotic guidance or freehand technique: a comparative study. Spine (Phila Pa 1976), 2018, 43(6): E373-E378.
17. Feng S, Tian W, Sun Y, et al. Effect of robot-assisted surgery on lumbar pedicle screw internal fixation in patients with osteoporosis. World Neurosurg, 2019, 125: e1057-e1062.
18. Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine, 2019, 8: 1-8.
19. Zhang Q, Xu YF, Tian W, et al. Comparison of superior-level facet joint violations between robot-assisted percutaneous pedicle screw placement and conventional open fluoroscopic-guided pedicle screw placement. Orthop Surg, 2019, 11(5): 850-856.
20. 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.
21. 李浩, 方宣城, 邱新建, 等. 機器人輔助與 “C” 型臂 X 線機透視經皮微創椎弓根螺釘內固定治療胸腰椎骨折療效的比較. 骨科臨床與研究雜志, 2018, 3(4): 200-204.
22. Hyun SJ, Kim KJ, Jahng TA, et al. Minimally invasive robotic versus open fluoroscopic-guided spinal instrumented fusions: a randomized controlled trial. Spine (Phila Pa 1976), 2017, 42(6): 353-358.
23. Kantelhardt SR, Martinez R, Baerwinkel S, et al. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J, 2011, 20(6): 860-868.

Chinese Journal of Reparative and Reconstructive Surgery

Robot-guided percutaneous kyphoplasty in treatment of multi-segmental osteoporotic vertebral compression fracture

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