Anatomy And Clinical Study Of Percutaneous Kyphoplasty

ObjectiveTo make out one optimalt technique for Kyphoplasty by transpedicular or transadjacent approach. We study the morphology of Chinese adult's thoracolumbar vertebral pedicle. Under direct vision, puncturation was performed on the dry vertebra specimens according to the image measurement and analysis. Standard lateral and horizontal radiographs were taken to help to observe the puncture angle and determine the puncture point on the pedicle posterior border. The technique was verified and evaluated through clinical application.Materials and Methods1. Ten adult's thoracolumbar vertebra specimens were studied, introversion angle and declination angle were measured on lateral and horizontal radiographs. We perform pedicle and adjacence puncturation on 5 thoracolumbar vertebra specimens according to the measurements. Verify the angles after puncturation.2. We treated 58 vertebral lesions with Kyphoplasty on the basis of the empirical study. Compared the patient's pain,the anterior/middle/posterior-height of every operative centrum,the angle of kyphoscoliosis before and after the operation. Patients were evaluated with postoperative plain radiographs and follow-up visit.3. SPSS 13.0 statistics software and Microsoft Excel were used to analysis measurements ,statistical method deploy t-test,one-factor analysis of variance and least significant difference statistics method,there is significance disparation (p<0.05).Results1 .The result of imageology:â‘ The introversion angles in the horizontal plane view varied evidently from T₅ to L₅.The angles ranged froml6.15°to18.95°from T₅ to T₈, 20.90°to24.05°from T₉toL₁,25.35°to39.45°from L₂ to L₅,.The averages of each group were compared and variance analyses were made. There were significant differences in the groups(P<0.01),There were no significant differences under right and left male and female contradistinction(P>0.05),â‘¡The puncturing obliquity in sagittal plane have no significant difference. The mean angles from 19.33°to 23.55°. There were no significant differences under male and female contradistinction (P>0.05).â‘¢Vertebre specimen sham operated: From T₅ to L₅ vertebral body was punctured according to introversion angle and declination angle,and then shoot X-ray,transfixion pin tip located vertebral body anterior posterior border middle point that ahead 1/3 sagittal line on the vertebral body horizontal plane, transfixion pin tip located vertebral body ante-below locality on the vertebral body sagittal plane.2.Clinical application result: PKP was applied to deal with 58 example thoracic and lumbar vertebrae osteporotic compression fracture. Patients were able to get out of bed and do some activities lor 3days after operation,The backache disappeared or was released significantly. VAS score was 1.8 points after operation, which was significantly decreased than 7.6 points preoperatively, P<0. 01. The mean Cobb angle was 11.2°,which was significantly decreased than 24.9°preoperatively, P<0.01. During 9 months follow-up, no obvious Cobb angle loss occurred. The postoperative anterior height were significantly higher than preoperative heights, which was 23. 9 mm VS15. 5 mm, P< 0. 01. There was no statistical difference between the post-operative and last follow-up of the scores of VAS,the mean Cobb angle and the postoperative anterior height(P>0.05).Patients were satisfactory about the treatment afte 3-12 months' follow-up. four cases were found scanty PMMP leak out without any nerve symptom.ConclusionsThe introversion angles of horizontal, and the width of narrow pedicle department were critical parameters for Kyphoplasty. According to the width of narrow pedicle department and the introversion angles of horizontal, trans-pedicular or trans-adjacent approach was applied to carry out Kyphoplasty. There was clear distinction in puncture angles for different vertebral segments. According to the parameters, trans-pedicular approach was preferred on L₂-L₅, trans-adjacent approach T₅-T₈.As for T₉-L₁, either approach would be applied based on the practical diameter of pedicle. Less diversity of entry angle was found in measurement of standard lateral radiographs. The puncture point for trans-pedicular approach was on the outside the top of the pedicle. In standard anterior posterior image,the entry points were at 10 o'clock on the left pedicle shadow and 2 o'clock on the right pedicle shadow respectively. The puncture point for trans-adjacent approach was on the tip of transverse process, at the axial line level. Clinical application results showed that Kyphoplasty could control pain caused by vertebral compression fracture, regain the height of vertebra body to some extent, correct kyphosis deformity, and improve the quality of life for patients.