Amar Arun Paul, Larsen Donald W, Teitelbaum George P
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Neurosurgery. 2003 Aug;53(2):380-2; discussion 383. doi: 10.1227/01.neu.0000073423.09308.40.
Percutaneous kyphoplasty is postulated to have several advantages over percutaneous vertebroplasty for the treatment of vertebral compression fractures and is gaining increased popularity. However, cement delivery with the KyphX kit (Kyphon, Inc., Santa Clara, CA), the only commercially available device for percutaneous kyphoplasty, is relatively problematic. This kit uses a series of "bone filler device" (BFD) tubes. Each BFD must be loaded manually with cement, which is then injected into the kyphoplasty cavity by manually depressing an inner stylet. The high profile of the BFD cannulas and their stylets requires frequent repositioning of the image intensifier tube and table. Because each accommodates only a small volume, the BFDs must be exchanged frequently. This delivery method also places the operator's hands directly in the field of radiation. We sought to overcome these limitations.
Dissatisfied with the shortcomings of the BFDs, we substituted the EZflow screw-syringe injector (Parallax Medical, Mountain View, CA) we use to deliver cement during conventional percutaneous vertebroplasty. This amalgam of the KyphX kit and the screw-syringe injector has been used for kyphoplasty treatment of 26 thoracolumbar compression fractures in 17 patients.
The screw-syringe injector allows controlled volumetric delivery of large boluses of high-viscosity cement without having to refill the reservoir. It minimizes radiation exposure and does not require repositioning of the x-ray tubes. It may theoretically allow decompression should cement extrusion occur. Also, it delivers cement to the interstices of bony trabeculae outside the kyphoplasty cavity, thus combining the mechanical benefits of percutaneous kyphoplasty and percutaneous vertebroplasty.
The use of a screw-syringe injector has several merits over the customary means of cement delivery during kyphoplasty.
经皮椎体后凸成形术被认为在治疗椎体压缩骨折方面比经皮椎体成形术有多个优势，且越来越受欢迎。然而，KyphX套件（Kyphon公司，加利福尼亚州圣克拉拉）是唯一可用于经皮椎体后凸成形术的商用设备，其骨水泥输送相对存在问题。该套件使用一系列“骨填充装置”（BFD）管。每个BFD都必须手动装入骨水泥，然后通过手动按压内部探针将其注入椎体后凸成形术腔。BFD套管及其探针外形较大，需要频繁重新定位影像增强管和手术台。由于每个BFD容纳的骨水泥量很少，必须频繁更换。这种输送方法还使操作者的手直接处于辐射区域。我们试图克服这些局限性。
由于对BFD的缺点不满意，我们改用了在传统经皮椎体成形术中用于输送骨水泥的EZflow螺旋注射器（Parallax Medical公司，加利福尼亚州山景城）。这种KyphX套件与螺旋注射器的组合已用于17例患者的26处胸腰椎压缩骨折的椎体后凸成形术治疗。
螺旋注射器能够控制高粘度骨水泥大剂量的定量输送，而无需重新填充储液器。它能将辐射暴露降至最低，且无需重新定位X射线管。理论上，如果发生骨水泥挤出，它可能允许减压。此外，它能将骨水泥输送到椎体后凸成形术腔外的骨小梁间隙，从而结合了经皮椎体后凸成形术和经皮椎体成形术的力学优势。
在椎体后凸成形术中，使用螺旋注射器在骨水泥输送方面比传统方法有多个优点。
