Ji Zhong-Wei, Shen Min-Jie, Sun Jia-Jia, Wang Jia-Le, Deng Yong-Kang, Zhang Yao, Wu Xie-Xing, Chen Kang-Wu, Mao Hai-Qing
Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Center for Rehabilitation Medicine, Department of Pain Management, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
Orthop Surg. 2025 Jan;17(1):125-132. doi: 10.1111/os.14269. Epub 2024 Oct 24.
Although percutaneous kyphoplasty (PKP) under C-arm guidance is an effective treatment for osteoporotic vertebral compression fractures (OVCF), obtaining high-definition images in patients with OVCF and spinal deformities can be challenging or insufficient using traditional C-arm guidance, prompting our institution to adopt the O-arm navigation system-which offers comprehensive 3D imaging and precise navigation-and this study compares its safety and efficacy with conventional C-arm-assisted PKP.
This was a retrospective study. From February 2019 to February 2022, we enrolled 28 patients with OVCF (44 vertebrae) with spinal deformity treated with O-arm navigation-assisted PKP and 30 patients with OVCF (42 vertebrae) with spinal deformity treated with C-arm-guided PKP. We recorded puncture times, single-segment operation time, number of cases with bone cement leakage, and length of stay. The visual analog scales (VASs), Oswestry disability indexes (ODIs), recovery of Cobbs angle, and vertebral height were used to assess treatment effect before the operation, on the first day postoperation, the first month postoperation, and at the final follow-up. The chi-squared test was utilized for comparing discrete variables, an independent samples t-test was used for continuous variables, and Pearson's chi-squared test and Fisher's exact test were applied for categorical data.
Demographic features were comparable between the groups. The O-arm navigation group showed a significant reduction in puncture adjustment per vertebrae, single-segment operation time, and the rate of trocar needle malposition compared to the C-arm guidance group. The rate of cement leakage was decreased in the O-arm-guided PKP group, and other complications did not differ between the two groups. Intragroup comparisons revealed significant improvements in VAS scores and ODI on the first day, first month, and final follow-up after the operation (p < 0.05). The VAS score was significantly lower in the O-arm navigation-assisted PKP group than in the C-arm-guided PKP group on the first day postoperatively (p = 0.049). However, no significant differences in VAS scores were observed between the groups at the first month postoperatively or at the final follow-up. In each follow-up period, there was no significant difference in ODI, Cobb angle, and the percent of anterior vertebral height (AVH %) between the groups.
O-arm navigation-assisted PKP demonstrates better clinical safety and efficacy than C-arm-guided PKP, marking it as a minimally invasive, safe, and effective procedure for treating patients with OVCF with spinal deformity.
尽管在C形臂引导下经皮椎体后凸成形术（PKP）是治疗骨质疏松性椎体压缩骨折（OVCF）的有效方法，但对于患有OVCF和脊柱畸形的患者，使用传统C形臂引导获取高清图像可能具有挑战性或不够充分，促使我们机构采用提供全面三维成像和精确导航的O形臂导航系统，本研究比较了其与传统C形臂辅助PKP的安全性和有效性。
这是一项回顾性研究。2019年2月至2022年2月，我们纳入了28例接受O形臂导航辅助PKP治疗的伴有脊柱畸形的OVCF患者（44个椎体）和30例接受C形臂引导PKP治疗的伴有脊柱畸形的OVCF患者（42个椎体）。我们记录了穿刺次数、单节段手术时间、骨水泥渗漏病例数和住院时间。使用视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）、Cobb角恢复情况和椎体高度来评估术前、术后第一天、术后第一个月和最终随访时的治疗效果。采用卡方检验比较离散变量，独立样本t检验用于连续变量，Pearson卡方检验和Fisher精确检验用于分类数据。
两组间人口统计学特征具有可比性。与C形臂引导组相比，O形臂导航组每个椎体的穿刺调整次数、单节段手术时间和套管针错位率显著降低。O形臂引导PKP组的骨水泥渗漏率降低，两组间其他并发症无差异。组内比较显示术后第一天、第一个月和最终随访时VAS评分和ODI有显著改善（p < 0.05）。术后第一天，O形臂导航辅助PKP组的VAS评分显著低于C形臂引导PKP组（p = 0.049）。然而，术后第一个月或最终随访时两组间VAS评分无显著差异。在每个随访期，两组间ODI、Cobb角和椎体前缘高度百分比（AVH%）无显著差异。
O形臂导航辅助PKP比C形臂引导PKP具有更好的临床安全性和有效性，标志着它是治疗伴有脊柱畸形的OVCF患者的一种微创、安全且有效的方法。
