Abstract：Objective To investigate the relative factors and prevention of puncture failure of percutaneous kyphoplasty.Methods A retrospective analysis of 473 osteoporotic vertebral compression fracture (OVCF) cases (577 vertebrae) who underwent PKP under C-arm X-ray in our hospital from February 2011 to May 2017，including 182 males and 291 females.The positive and lateral radiographs and CT of the operation section were recorded 2 days after operation and after one month，and the anatomic location of the failed puncture was recorded.Results There were 577 vertebral bodies in 473 patients.The puncture failed in 42 vertebral bodies in 42 cases.The rate of puncture failure was 7.3％.Among them，there were 8 cases of pedicle type，8 cases of endplate type ，16 cases of lateral wall type and 10 cases of anterior wall type.Conclusion The keys to prevent puncture failure are understanding of image changes of OVCF，standardrized image perspective，skilled operation and multi azimuth C arm image.
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