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.	刘博, 谷元, 王鹏, 等. 椎体后凸成形术治疗 580 例老年性骨质疏松性椎体压缩性骨折疗效的影响因素分析. 中国骨质疏松杂志, 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.	任志伟, 尹思, 王莹, 等. 经皮椎体后凸成形术治疗多节段骨质疏松性椎体压缩性骨折的疗效分析. 实用骨科杂志, 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, 谭伦, 林旭, 等. 光电导航引导单侧穿刺椎体后凸成形术治疗胸腰椎骨质疏松性椎体压缩骨折. 中国修复重建外科杂志, 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.	杨俊松, 郝定均, 刘团江, 等. 脊柱机器人与透视辅助下经皮植钉治疗腰椎滑脱症中植钉精度的对比研究. 中国修复重建外科杂志, 2018, 32(11): 1371-1376.
10.	徐鹏, 葛鹏, 章仁杰, 等. 机器人辅助下椎弓根螺钉固定治疗胸腰椎骨折. 颈腰痛杂志, 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, 刘艺明, 等. 椎体成形与弯角椎体成形治疗骨质疏松性椎体压缩骨折: 骨水泥注射后分布与渗漏率的比较. 中国组织工程研究, 2020, 24(10): 1484-1490.
13.	张在田, 张绪华, 卫志华, 等. 机器人辅助与徒手单侧穿刺椎体成形术治疗骨质疏松性椎体压缩骨折疗效的比较. 骨科临床与研究杂志, 2018, 3(4): 205-208.
14.	田野, 张嘉男, 陈浩, 等. 脊柱机器人与传统透视辅助下微创经皮复位内固定术治疗单节段无神经症状胸腰椎骨折对比研究. 中国修复重建外科杂志, 2020, 34(1): 69-75.
15.	林书, 胡豇, 万仑, 等. 机器人辅助下经皮微创椎弓根螺钉内固定与传统开放内固定治疗胸腰椎骨折的短期疗效比较. 中国修复重建外科杂志, 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, 马维虎, 等. 经皮椎体后凸成形术中单侧经椎弓根穿刺角度与骨水泥分布情况的关系. 临床骨科杂志, 2012, 15(3): 241-244.
21.	李浩, 方宣城, 邱新建, 等. 机器人辅助与 “C” 型臂 X 线机透视经皮微创椎弓根螺钉内固定治疗胸腰椎骨折疗效的比较. 骨科临床与研究杂志, 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. 刘博, 谷元, 王鹏, 等. 椎体后凸成形术治疗 580 例老年性骨质疏松性椎体压缩性骨折疗效的影响因素分析. 中国骨质疏松杂志, 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. 任志伟, 尹思, 王莹, 等. 经皮椎体后凸成形术治疗多节段骨质疏松性椎体压缩性骨折的疗效分析. 实用骨科杂志, 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, 谭伦, 林旭, 等. 光电导航引导单侧穿刺椎体后凸成形术治疗胸腰椎骨质疏松性椎体压缩骨折. 中国修复重建外科杂志, 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. 杨俊松, 郝定均, 刘团江, 等. 脊柱机器人与透视辅助下经皮植钉治疗腰椎滑脱症中植钉精度的对比研究. 中国修复重建外科杂志, 2018, 32(11): 1371-1376.
10. 徐鹏, 葛鹏, 章仁杰, 等. 机器人辅助下椎弓根螺钉固定治疗胸腰椎骨折. 颈腰痛杂志, 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, 刘艺明, 等. 椎体成形与弯角椎体成形治疗骨质疏松性椎体压缩骨折: 骨水泥注射后分布与渗漏率的比较. 中国组织工程研究, 2020, 24(10): 1484-1490.
13. 张在田, 张绪华, 卫志华, 等. 机器人辅助与徒手单侧穿刺椎体成形术治疗骨质疏松性椎体压缩骨折疗效的比较. 骨科临床与研究杂志, 2018, 3(4): 205-208.
14. 田野, 张嘉男, 陈浩, 等. 脊柱机器人与传统透视辅助下微创经皮复位内固定术治疗单节段无神经症状胸腰椎骨折对比研究. 中国修复重建外科杂志, 2020, 34(1): 69-75.
15. 林书, 胡豇, 万仑, 等. 机器人辅助下经皮微创椎弓根螺钉内固定与传统开放内固定治疗胸腰椎骨折的短期疗效比较. 中国修复重建外科杂志, 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, 马维虎, 等. 经皮椎体后凸成形术中单侧经椎弓根穿刺角度与骨水泥分布情况的关系. 临床骨科杂志, 2012, 15(3): 241-244.
21. 李浩, 方宣城, 邱新建, 等. 机器人辅助与 “C” 型臂 X 线机透视经皮微创椎弓根螺钉内固定治疗胸腰椎骨折疗效的比较. 骨科临床与研究杂志, 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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