O型臂导航引导下经皮椎体成形术治疗中段胸椎骨质疏松性椎体压缩骨折的精准性及安全性

目的 探讨O型臂导航引导下经皮椎体成形术（percutaneous vertebroplasty，PVP）在治疗中段胸椎骨质疏松性椎体压缩骨折的精准性及安全性。方法 2019年12月—2021年8月复旦大学附属浦东医院骨科收治中段胸椎骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture，OVCF）患者15例（15个椎体），男5例，女10例；年龄70~89岁，平均（76.7±5.8）岁。均采用O型臂导航引导下经单侧穿刺行PVP治疗。主要疗效指标：术中规划路径与实际路径的符合率，微创经皮开路器穿刺成功需要的次数，主要指标用于评价该手术操作的精准性。次要疗效指标包括：记录患者术前、术后2天以及末次随访时视觉模拟（visual analogue scale，VAS）疼痛评分，Oswestry功能障碍指数（Oswestry disability index，ODI）。同时记录患者的手术时间、骨水泥使用量、术中出血量及手术相关并发症发生情况等，测量并记录术前、术后2天及末次随访时伤椎前缘高度，次要指标用于评价该手术方案的临床疗效与安全性。结果 15例患者均顺利完成手术，术中规划路径与实际路径的符合率：优6例，良9例，优良率达100%，所有病例均为1次穿刺成功，无患者出现骨水泥渗漏或严重并发症。平均随访11.7个月。术前、术后2天及末次随访时患者VAS评分分别为7.2±0.7、2.3±0.5和1.9±0.5，患者ODI评分分别为68.1±4.0、23.6±4.3和23.0±4.6，患者伤椎前缘高度分别为（2.4±0.3）cm、（2.7±0.3）cm和（2.6±0.3）cm。术后2天患者VAS评分、ODI评分较术前明显改善（P<0.05），术后2天及末次随访时患者伤椎前缘高度较术前均增加（P<0.05）。结论 O型臂导航引导下PVP治疗中段胸椎OVCF，可提高手术操作精准度及安全性，在治疗中段胸椎OCVF中可能具有较大的临床应用价值。

Accuracy and safety of percutaneous vertebroplasty assisted by O-arm-based navigation for treatment of osteoporotic vertebral compression fracture at midline thoracic vertebra

Objective To investigate the accuracy, safety and clinical efficacy of PVP (percutaneous vertebroplasty)assisted by the O-arm-based navigation for the treatment of osteoporotic vertebral compression fractures at the midline thoracic vertebrae.Methods From Dec 2019 to Aug 2021, 15 patients (15 vertebraes) with osteoporotic vertebral compression fracture (OVCF)at the midline thoracic vertebrae were treated in Fudan University Pudong Medical Center. There were 5 males and 10 females, the average age was (76.7±5.8)years (70-89 years old).All patients underwent percutaneous vertebroplasty assisted by the O-arm-based navigation. The coincidence rate of actual puncture path and intraoperative planning puncture path and the number of times for successful puncture were regarded as the primary outcomes in order to evaluate the accuracy of the operation. Visual analogue scale (VAS) pain score and Oswestry dysfunction index (ODI) were recorded before operation, 2 days after operation and final follow-up. At the same time, the operation time, the usage amount of bone cement, the amount of bleeding and the occurrence of operation-related complications were recorded, and the height changes of the anterior edge of the injured vertebrae were measured and recorded before operation, 2 days after operation and the final follow-up, the above indicators were regarded as secondary outcomes for evaluating the efficacy and safety of the operation.Results All the 15 patients completed the operation successfully, the coincidence rate of actual puncture path and intraoperative planning puncture path was 100%, all patients were punctured successfully at one time and no bone cement leakage or serious complications occurred. The patients were followed up for a mean time of 11.7 months.The VAS pain score before operation, 2 days after operation and the final follow-up was 7.2±0.7, 2.3±0.5 and 1.9±0.5, respectivelyand ODI was 68.1±4.0, 23.6±4.3 and 23.0±4.6, respectively.And the height of the anterior edge of the injured vertebrae before operation, 2 days after operation and the final follow-up was (2.4±0.3) cm, (2.7±0.3) cm and (2.6±0.3) cm, respectively. The VAS pain score and ODI of the patients were significantly improved after the operation.There was a significant increase in the height of the anterior edge of the injured vertebra 2 days after operation and the last follow-up (P < 0.05). At the final follow-up, there was no significant difference between the above-mentioned indexes at the final follow-up and 2 days after operation.Conclusion PVP via unilateral extrapedicular approach assisted by the O-arm-based navigation, which may be a safe, accurate and effective method for the treatment of OVCF in the midline thoracic vertebrae.