Application of bidirectional laser positioning fluoroscopy by G-arm X-ray with unilateral injection of bone cement in senile osteoporosis with pathologic fractures

YAN Jun; XIAO Jian; LI Hao; HU Fan; WANG Ce; LIANG Haojun; GUO Jing; XING Gengyan

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Medical Journal of the Chinese People Armed Police Forces ›› 2024, Vol. 35 ›› Issue (11) : 959-964.

Application of bidirectional laser positioning fluoroscopy by G-arm X-ray with unilateral injection of bone cement in senile osteoporosis with pathologic fractures

YAN Jun¹, XIAO Jian¹, LI Hao¹, HU Fan¹, WANG Ce¹, LIANG Haojun¹,GUO Jing¹, XING Gengyan^1,2

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Abstract

Objective To investigate the effect of bidirectional laser positioning fluoroscopy by G-arm X-ray with unilateral injection of bone cement in senile osteoporosis with pathologic fractures. Methods The clinical records of 118 elderly patients with osteoporotic vertebral compression fractures concurrent with pathological breaks treated by the Third Medical Center of PLA General Hospital between February 2021 and February 2023 were retrospectively analyzed. These patients were divided into two groups according to different imaging techniques. The control group (n=63) received percutaneous vertebroplasty (PVP) or balloon kyphoplasty (PKP) with the assistance of a C-arm fluoroscopy device, and the experimental group (n=55) received PVP or PKB under the guidance of a G-arm fluoroscope. An evaluative comparison of the pre-operative and post-operative Visual Analog Scale (VAS) scores, the degree of vertebral body compression anteriorly, and the kyphotic deformation measured by the Cobb angle was carried out between the two groups, and the postoperative cement leakage and recurrence of adjacent vertebral fractures were recorded. Results There were significant differences between the two group in the time of operation, the duration of X-ray fluoroscopy, the injection amount of PMMA bone cement, the times of X-ray fluoroscopy and the time from stirring to injection (P<0.05). The interaction between operation mode and time and operation method and duration had significant effects on VAS scores, with statistical difference (P<0.05). The VAS score of the experimental group was lower than that of the control group at the time point of the 3rd day after surgery, and the difference was statistically significant (P<0.05). There was no significant difference in Cobb Angle between anterior compression and posterior process between the patients with the type and time of operation. However, in terms of the main effects, the differences in these parameters were statistically significant (P<0.05). Assessments conducted at three-day intervals and again one year after the operation revealed substantial changes in the anterior height of the vertebrae and adjustments to the Cobb angle. The experimental group displayed a significantly decreased angle of kyphosis in relation to the control group (P<0.05). The postoperative bone cement leakage rate in the experimental group was 3.64%, lower than that in the control group (15.87%), and the difference was statistically significant (P<0.05). There was no significant difference in the recurrence rate of adjacent vertebral fractures 3 months and 12 months after surgery between the two groups. Conclusions Unilateral injection of bone cement by bidirectional laser positioning fluoroscopy is a safe and effective treatment method, which can relieve pain, restore vertebral shape and stability, and reduce the risk of bone cement leakage, and has potential clinical promotion value in the clinical application of senile osteoporosis with pathological fractures.

Key words

bidirectional laser positioning fluoroscopy / unilateral injection of bone cement / senile osteoporosis / pathological fracture

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YAN Jun, XIAO Jian, LI Hao, HU Fan, WANG Ce, LIANG Haojun,GUO Jing, XING Gengyan. Application of bidirectional laser positioning fluoroscopy by G-arm X-ray with unilateral injection of bone cement in senile osteoporosis with pathologic fractures[J]. Medical Journal of the Chinese People Armed Police Forces. 2024, 35(11): 959-964

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