Percutaneous vertebroplasty and kyphoplasty

Osteoporotic vertebral compression fractures are common fractures in the elderly. Traditionally, non-surgical treatment or surgical treatment is used, and the results are not satisfactory. In recent years, percutaneous vertebral body injection of fillers for vertebral body strengthening (called vertebroplasty), or the use of balloons or other mechanical devices to open the compressed vertebral body, so that the kyphosis is partially or completely After correction, the filler is injected into the vertebral body strengthening (called kyphoplasty), which can achieve the purpose of stabilizing the fracture, restoring the mechanical strength of the vertebral body and relieving pain. Percutaneous vertebroplasty or kyphoplasty is a minimally invasive procedure that relieves the pain rate of osteoporotic vertebral compression fractures by 75% to 95%. Treating diseases: osteoporosis Indication Percutaneous vertebroplasty and posterior plasty are applicable to: 1. Complete fresh osteoporotic compression fracture of the posterior margin of the vertebral body. 2. In the recent vertebral compression fracture caused by osteoporosis, the posterior margin of the vertebral body is intact but the anterior column collapse of the vertebral body is gradually aggravated, and the pain continues. 3. Osteoporosis. 4. Palliative treatment of vertebral tumors (analgesia and prevention of pathological fractures leading to nerve damage). Contraindications 1. Severely compressed fracture, the vertebral body is compressed to less than 1/3 of the original height, and the lumbar vertebrae is compressed by 75%. 2. There are neurological symptoms, such as tumors or fractures that compress the nerves or the spinal cord. 3. High speed trauma. 4. Vertebral osteomyelitis. 5. Patients with bleeding disorders. Preoperative preparation 1. Determining the vertebral body that produces pain: Compression fractures of a single vertebral body, such as X-ray films and local pain in the body, can be clearly identified as the site of the fracture. If there are multiple vertebral body wedge deformation, but it can not be determined that the fresh fracture should be performed MRI examination, the T2 weighted image showed a high signal for the fresh fracture vertebral body. 2. Iodine allergy test: If a balloon is selected as a dilator (posterior angioplasty) and an iodine-containing developer is to be injected, an iodine allergy test should be performed. 3. If local anesthesia is used, a venous access should be established, and ECG monitoring should be performed at the same time, and the patient should be advised of discomfort such as pain and pain when performing vertebral puncture and filling of the filler. Surgical procedure 1. Clear puncture approach The vertebral canal approach can be used for patients with lesions below the chest 8 and the pedicle approach should be used for patients with lesions above 8 on the chest. 2. Transpedicular approach This approach puncture needle always travels within the pedicle. After fluoroscopy to determine the vertebral body to be treated, such as in the left pedicle puncture, enter the pedicle point and select the upper edge of the pedicle to be called 10 points; as in the right pedicle, puncture At the pedicle point, the upper edge of the pedicle is selected as the 10th point, that is, the part usually called 10:10 is inserted into the pedicle. Under fluoroscopy (positive position), the puncture needle tip is located at the above two points, and puncture at the skin projection point (if local anesthesia is used, anesthesia should be performed near the needle insertion point of the pedicle in addition to skin anesthesia). Make a 0.5cm incision in the skin, insert the puncture needle inward and downward puncture, and then see through the cortical bone after contact, and confirm that the needle tip is located at the outer edge of the pedicle at 10 or 10 points. The direction passes through the pedicle and then penetrates. When the needle tip approaches the medial edge of the pedicle in the ortho position, the lateral perspective needle tip should have passed the pedicle through the posterior edge of the vertebral body. If this standard is not met, the inner and outer tilt angles of the needle should be adjusted. If the position is correct, the needle is inserted into the first 1/3 of the vertebral body, which is close to or at the center of the vertebral body. 3. Transpedicular approach This approach puncture needle first passes through the transverse process, along the lateral side of the pedicle, and enters the vertebral body at the junction of the pedicle and the vertebral body. Under fluoroscopy (positive position), the puncture needle tip is located at the above two points, and is puncture 1.5 cm above the projection point of the pedicle skin. (If local anesthesia is used, anesthesia should be performed near the needle point of the transverse process except for skin anesthesia. ). Make a 0.5cm incision in the skin, insert the puncture needle inward and downward puncture, and then see through the cortical bone and then see through it. Confirm that the orthotopic needle point should be selected from the outer edge of the pedicle outer edge, that is, the outer edge of the pedicle is 10 points. 10 points in the azimuth. The direction of the needle on the lateral position passes through the pedicle and then penetrates. The needle penetrates the transverse protrusion and travels between the pedicle and the rib neck. When the needle tip reaches the lateral edge of the pedicle in the ortho position, the lateral perspective needle tip should have passed through the pedicle to reach or exceed the posterior edge of the vertebral body. If this standard is not met, the inner and outer tilt angles of the needle should be adjusted. If the position is correct, the needle is inserted into the first 1/3 of the vertebral body, which is close to or at the center of the vertebral body. 4. Vertebroplasty Perform the appropriate operation depending on the instrument used. Take bone cement as a filler as an example: (1) Direct injection method of the syringe: After the bone cement is prepared and put into a 1 ml or 2 ml syringe to be in the toothpaste period, the puncture needle core is removed and directly injected into the vertebral body. (2) Casing push rod injection method: the puncture needle core is removed, the guide wire is inserted, and then the puncture needle is removed, and the guide wire is inserted into the thicker working sleeve beyond the posterior edge of the vertebral body by 2 mm, and the guide wire is taken out, the same After the bone cement is prepared and put into the pusher sleeve to be in the toothpaste period, the cement is inserted into the 1/3 of the vertebral body through the working sleeve. 5. Posterior angioplasty Remove the puncture needle, insert the guide wire, and then remove the puncture needle. Insert the thicker working cannula into the thicker working cannula 2mm beyond the posterior edge of the vertebral body; or directly puncture with the puncture needle with the working cannula, reach the puncture needle When the vertebral body is 1/3 behind, the working sleeve is pushed along the puncture needle to 2 mm beyond the posterior edge of the vertebral body, and the puncture needle is taken out. The tap is inserted into the working cannula, and the enlarged passage in the vertebral body is pulled out 3 to 5 mm from the leading edge of the vertebral body. Pump a high-pressure syringe with a pressure gauge into the contrast agent at least 20ml, connect the balloon with the balloon at the head end, and then vent the gas. Insert the balloon end into the tip of the channel at the leading edge of the vertebral body, and inject the contrast agent into the balloon. When the pressure reaches 50 psi, the probe in the balloon catheter is removed and the contrast agent is injected. The balloon dilation and fracture reduction were observed under fluoroscopy, and the cortical wall of the vertebral body was to remain intact. Under normal circumstances, the pressure of the balloon should not exceed 300 psi. The bone cement is injected after the balloon is expanded. The method is the same as the cannula pusher injection method. The amount of bone cement injected after the expansion of the balloon of 15 mm length should not exceed 4 ml, and the balloon of 20 mm length should not exceed 6 ml after expansion. 6. After the bone cement is injected, the working sleeve and the push rod sleeve are removed together. The incision can be attached with a band-aid. complication 1. Bone cement leakage. 2. Unilateral neuralgia or radiation pain. 3. Spinal cord compression. 4. Epidural hematoma. 5. Hypoxia and fever. 6. Blood chest. 7. Pulmonary edema. 8. Death.