Analysis of the efficacy of 3D-printed puncture guides to optimise PVP in the treatment of osteoporotic vertebral compression fractures

Objectives: To investigate the safety and feasibility of 3D-printed puncture guides assisting unilateral approach percutaneous vertebroplasty (PVP) for the treatment of osteoporotic vertebral compression fracture (OVCF). Methods: We retrospectively analyzed the medical records of 106 patients admitted to the Department of Spine Surgery of the Affiliated Hospital of Yan'an University who underwent percutaneous vertebroplasty with unilateral approach during the period of June 2020-2022, and divided them into 2 groups according to whether or not they were using 3D-printed perforation guides during the operation: 52 cases in the 3D-printed perforation guide-assisted PVP groups (Observation groups), and 54 cases in the traditional PVP groups (Control groups). The general information, operation time, puncture time, number of intraoperative C-arm fluoroscopies, amount of bone cement injected, postoperative complications, whether the trajectory of the puncture needle broke through the inner and outer walls of the pedicles, and the degree of compression of the anterior margin of the vertebral body and the Cobb's angle, which were measured on the lateral views of the injured vertebrae before and after operation, were recorded and compared between the two groups, and the visual analogue scale for pain was used to evaluate the pain in the injured vertebral area. A visual analogue scale (VAS) was used to evaluate the degree of pain in the injured vertebral region, and the Oswestry Disability Index (ODI) was used to assess the degree of functional disability of the patients. Results: ①There was no statistically significant difference between the two groups in terms of gender, age, body mass index (BMI), bone mineral density (BMD), injured segment, and other preoperative general information (P>0.05). ②The operation time, intraoperative puncture time, and cement leakage rate of the observation group were less than those of the control group (P<0.05), and the incidence of nerve root injury symptoms, cement as a whole, contralateral diffusion volume ratio, and puncture path breaching the inner and outer walls of the pedicles were significantly less than those of the control group (P<0.05), ③The degree of vertebral anterior compression in the observation group at 1 day postoperatively (21.01±1.98)% was significantly lower than that in the control group ( 23.21±2.47)% compared with the control group (P<0.05), ④The amount of bone cement injection and the incidence of adjacent vertebral fracture were not statistically significant (P>0.05), ⑤There was no statistically significant difference in the comparison of the VAS scores and ODI scores of the two groups in the postoperative period and during the postoperative follow-up period (P>0.05). Conclusion: 3D-printed puncture guide assisted unilateral approach percutaneous vertebroplasty for the treatment of single-segment OVCF has significant clinical advantages, compared with the traditional unarmed puncture group, it improves the ratio of the overall, contralateral dispersion volume of the bone cement, can accurately guide the puncture, significantly improves the accuracy of puncture and reduces the occurrence of surgical complications, and also reduces the number of fluoroscopies, shortens the operation time, and all-roundly improves the surgical safety and operation efficiency.