| Objective.China has entered an aging society and people over 60 years old has reached 249 million,accounting for 17.9% of the total population.The average life expectancy for men is 72.3 years and for women is 77.3 years.With the age increased,adverse events such as hip,wrist and thoracolumbar fractures are extremely common in clinical practice.At present,osteoporotic thoracolumbar vertebral compression fracture(OVCF)can be treated by percutaneous kyphoplasty(PKP).The puncture point located at the outer upper edge of the pedicle and the puncture angle is 10o’clock on the left and 2 o’clock on the right.However,during the subsequent puncture into the vertebral body,it is not described in detail how the puncture needle reaches or approaches the midline position of the vertebral body through the pedicle,and how much abduction angle is given during the operation.Therefore,puncture failure often leads to related complications.The purpose of this study is to measure the preoperative CT to determine the trajectory of the puncture needle,and accurately establish the working channel under the monitoring of the C-arm during the operation,thereby reducing the incidence of puncture complications and bone cement leakage.Methods.A total of 100 patients with single-segment OVCF accepted PKP in Tianjin Hospital,and 89 patients received clinical follow-up for more than 1 year.According to the puncture method,patients were divided into two groups.Fifty-one cases in observation group,which contains 15 males and 36 females,with an average age of(66.7 ± 13.2)years,the PKP was performed according to preoperative CT measurement combined with intraoperative precise puncture.Thirty-eight cases in control group,which contains 11 males and 27 females,the average age was(67.3±13.8)years,and were treated by conventional PKP.The operative time,intraoperative fluoroscopy times,changes of Cobb angle and the vertebral body height was observed and recorded.The visual analogue scale(VAS)was used to evaluate the postoperative pain relief.The Oswestry dysfunction index was used to evaluate the improvement of patients’ quality of life.X-rays and CT scans were taken to determine the distribution of bone cement and the occurrence of bone cement leakage.Results.All patients were been operated successfully without spinal cord and nerve root injuries.In observation group,the operative time was(43.1 ± 5.1)min and the intraoperative fluoroscopy times were(41.5 ± 5.8),which was(47.8±6.3)min and(49.7±6.5)respectively in control group(P < 0.05).The cement injection volume in observation group was(3.3±0.5)ml,and in control group was(3.2±0.6)ml(P > 0.05).Both groups had a significant decrease in VAS score when compared with the preoperative level(P < 0.05).There was no significant difference between groups at different time points(P > 0.05).After the waist pillow,the height of the injured vertebra recovered significantly when compared with the former level(P < 0.05).After PKP treatment,the height of the injured vertebra was further recovered compared with that after waist pillow(P < 0.05).There was no significant difference between groups at different time points(P > 0.05).The pre-operative Cobb angle was significantly decreased when compared with the level at admission,and the difference was statistically significant(P < 0.05).After PKP treatment,the Cobb angle was further recovered compared with pre-operation,and there was a significant statistical difference(P < 0.05).There was no significant difference between the two groups at different time points(P > 0.05).The Oswestry dysfunction index in the two groups showed a decreasing trend after the surgery,there was a significant difference before and after surgery(P < 0.05).There was no significant difference between the two groups at different time points(P > 0.05).During the operation,90.2%(46/51)of the patients in observation group diffused the bone cement beyond the midline of the vertebral body,compared with 76.3%(29/38)in the control group,there was a significant statistical difference between the two groups(P <0.05).After CT scan,it was found that the incidence of bone cement leakage in observation group was 11.8%(6/51),and in control group,it was 28.9%(11/38)(P < 0.05).Conclusions.At present,to achieve accurate puncture of the vertebral body,the surgeon needs to use a robot or an O-arm to complete it.Before the operation,CT measurement is used to determine the trajectory of the puncture needle,and the method of establishing a working channel under the supervision of the C-arm during operation can also achieve fracture Accurate puncture of the vertebral body.Precision puncture can reduce the operation time and the number of intraoperative fluoroscopy,and make the bone cement diffuse better to the opposite side of the vertebral midline,the load of the fractured vertebral body is more uniform,and the leakage rate when the bone cement is injected is lower;in addition,the operation There is no obvious difference between the puncture method and the conventional puncture method in relieving local pain and promoting the recovery of the injured vertebral height. |
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