Study On Navigation Of PVP And PKP In Treatment Of Thoracolumbar Fracture And Risk Factors For Refracture After Surgery

Background:With the increasing of the elderly population in China,the incidence of Osteoporosis(OP)is still at a high level.Osteoporotic vertebral compression fracture(OVCF)is the most common type of osteoporotic fracture,which brings serious physical and mental harm to individuals,as well as heavy economic burden to family and society.With the progress of science and technology,PVP and PKP have gradually become the main surgical methods for thoracolumbar fracture due to little trauma.However,there are some defects in traditional navigation methods.It is vital to explore a new,simple,safe,easy,real-time navigation method for PVP and PKP.Secondly,it has been found in clinical practice that patients with OVCF may suffer from new vertebral fractures after PVP and PKP.Nowadays,there are many controversies about the risk factors for new fractures after PVP and PKP.Objectives:1.To assess the safety and effectiveness of ECD assisting PVP and PKP in the treatment of OVCF.2.To explore the independent risk factors of new vertebral fractures after PVP and PKP for osteoporotic thoracolumbar vertebral compression fractures,and establish a prediction model for the risk of new vertebral fractures.Methods:1.Sixty one OVCF patients who underwent PVP or PKP in the spine surgery of our hospital from December 2018 to December 2019 were prospectively studied.In a randomized self-controlled experimental design,vertebra was randomly divided into a control group and an ECD group.The control group was punctured with a common puncture needle under C-arm navigation,and the experimental group was punctured with ECD.The puncture time,fluoroscopy times and neurovascular complications of the two groups were compared.The safety and effectiveness of the ECD in different subgroups were analyzed according to the AVH and the surgeon.2.A retrospective analysis was performed on one hundred and thirty patients diagnosed with osteoporotic thoracolumbar compression fractures who underwent PVP or PKP surgery in the department of spine surgery of our hospital from January 2015 to December 2019.According to whether there were new vertebral fractures or not after PVP or PKP,they were divided into two groups: the refracture group and the non-refracture group.Age,gender,BMI,BMD,history of fracture,number of operative vertebrae,PVP/PKP,the difference between preoperative and postoperative anterior vertebral height,the difference between preoperative and postoperative local kyphosis,the average volume of bone cement injection and cement leakage were compared between the two groups.The statistically significant risk factors were conducted in multivariate logistic regression analysis to confirm independent risk factors of refracture.Finally,the prediction model of the risk of new vertebral fractures after PVP and PKP for osteoporotic thoracolumbar fractures was established.Results:1.61 patients(44 women,17 men),including 75 vertebrae,were enrolled in this study.Compared with conventional puncture under c-arm fluoroscopy,puncture time of the ECD was significantly reduced(504.33±152.03 vs 652.68±167.60 seconds;P <0.05),the frequency of fluoroscopy significantly decreased(5.11±1.23 vs 8.15±1.83;P < 0.001).Puncture time and fluoroscopy times in VCFs > 50% group were significantly higher than those in VCFs ≤50% group.In the subgroup with VCFs > 50%,the puncture time and the fluoroscopy times in the ECD group were significantly decreased with the increase of the number of cases.There were no neurovascular complications.2.The study found that age,bone mineral density,history of fractures,number of operative vertebrae,the difference between preoperative and postoperative local kyphosis were statistically significant correlated with refracture after PVP and PKP for OVCF(P <0.05).However,gender,BMI,PVP/PKP,the difference between preoperative and postoperative anterior vertebral height,the average volume of bone cement injection and bone cement leakage were not statistically significant correlated with refracture after PVP and PKP(P>0.05).The above factors were conducted into the multivariate logistic regression analysis.Elderly patients,lower bone mineral density,history of fractures and multiple surgical segments are independent risk factors for postoperative new vertebral fractures.We set up prediction model of refracture’s risk after PVP and PKP.According to the AUC,decision-making curve and calibration curve,the model fitting effect is good.Conclusions:1.The ECD can reduce the puncture time,the times of fluoroscopy,the radiation of surgeons and patients.There are no neurovascular complications.Moreover,it can real-time navigate the puncture process through acoustic and optical signals.Besides,the design of tshaped handle does not change the operation habits of surgeons.Therefore,it is a simple,portable,safe,effective,easy to grasp,and real-time navigation device.And it is suitable for the treatment of thoracolumbar fracture with more than 50% of the AVH.2.Elderly patients,lower BMD,multiple surgical segments,history of fractures are independent risk factors of refracture after PVP and PKP for OVCF patients.It is vital to pay attention to the treatment of osteoporosis,especially in elderly patients,history of fractures and multiple surgery segments.We made the prediction model of the risk of refracture to evaluate the risk of new fractures after PVP and PKP.