骨质疏松性椎体压缩性骨折经皮椎体后凸成形术中骨水泥渗漏原因回顾性分析

摘要

目的回顾性分析骨质疏松性椎体压缩性骨折（ osteoporotic vertebral compressive fracture ， OVCF）经皮椎体后凸成形术（ percutaneous kyphoplasty ， PKP）中骨水泥渗漏的原因。方法对昆山市中医医院2014年1月－2016年3月接受PKP治疗的311例OVCF患者370个椎体进行回顾性分析，总结造成骨水泥渗漏的原因及预防方法。结果370个椎体中有77个出现骨水泥渗漏，68个椎体为单处渗漏，9个椎体为两处渗漏， Yeom分型C型52个、 B型9个、 S型5个，另有20个椎体出现椎弓根内（针道）渗漏，未出现远隔器官栓塞，骨水泥渗漏患者未出现不良反应。单因素Logistic回归分析结果显示，性别、年龄、骨折部位、同时手术椎体数与骨水泥渗漏无相关性（P＞0.05），而穿刺方式、受伤至手术时间、骨水泥注入量与骨水泥渗漏有相关性（ P＜0.05）；多因素Logistic回归分析结果显示骨水泥注入量与骨水泥渗漏相关（ P＜0.05），而受伤至手术时间、穿刺方式与骨水泥渗漏无相关性（ P＞0.05）。结论 PKP是治疗OVCF的安全，有效方法，骨水泥渗漏与骨水泥注入量有关。%Objective To retrospectively analyze the reasons of bone cement leakage in percutaneous ky-phoplasty ( PKP) in the treatment of osteoporotic vertebral compression fracture.Methods We retrospectively re-viewed 311 patients with 370 vertebrae who underwent PKP for OVCF from January 2014 to March 2016 .The rea-sons of bone cement leakage and preventive measures were summarized.Results Bone cement leakage was found in 77 of the 370 treated vertebrae.Single leakage was found in 68 vertebrae whereas two leakages in 9 vertebrae.There were 52 C-type, 9 B-type and 5 S-type according to Yeom's classification and 20 nails in vertebral pedicle.No distal organ embolism was found.None of patients with cement leakage suffered from any sides effects.Univariate Logistic regression analysis showed that gender, age, site of fracture and surgical vertebral number had no correlation with cement leakage (P>0.05), and puncture, injure to operation time, cement volume correlated to cement leakage ( P<0.05 ) .Multivariate logistic regression analysis showed that cement volume correlated to cement leakage ( P<0.05) and injure to operation time, puncture had no correlation with cement leakage (P >0.05).Conclusion PKP is a safe and effective surgical technique for the treatment of OVCF .Cement leakage in PKP correlated to the quantity of cement.