椎体成形术骨水泥渗漏的相关危险因素分析

摘要

Objective To investigate the related risk factors of bone cement leakage after percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) of osteoporotic vertebral compression fracture.Methods A retrospective study was made on 108 patients (114 vertebrae) undergone PVP and PKP between January 2008 and June 2014.There were 32 patients with cement leakage and 76 patients without cement leakage.Between-group differences were analyzed in terms of gender,age,number of one-time treated vertebrae,anatomic dissection,surgical procedures (PKP or PVP),integrity of the posterior vertebral wall,puncture approaches (unilateral or bilateral),technical level of surgeons and bone cement volume.Results Bone cement leakage occurred in 36 vertebrae (with the proportion of 31.6％).Cement leakage was associated with number of one-time treated vertebrae,surgical procedures,fractured condition,and bone cement volume (P ＜ 0.05),but not with gender,age,anatomical site of injury,puncture approaches,and technical level of surgeons (P ＞ 0.05).Conclusions Bone cement leakage after PKP or PVP correlated with number of vertebrae with one-time therapy,surgical procedures,fractured condition,and volume of bone cement.A good master of technical procedures and indications and suitable injection of high viscosity bone cement can help reduce the incidence of cement leakage.%目的 探寻经皮椎体成形术(PVP)与经皮后凸成形术(PKP)治疗椎体骨质疏松性压缩性骨折出现骨水泥渗漏的相关危险因素.方法 回顾性分析2008年1月-2014年6月收治的PVP和PKP患者108例(114个椎体).根据是否出现骨水泥渗漏将患者分为骨水泥渗漏组(32例)和无骨水泥渗漏组(76例),对两组患者的性别、年龄、一次性治疗椎体的个数、伤椎解剖位置、术式选择(PKP或PVP)、椎体后壁的完整性、穿刺方式(单侧或双侧)、医师的技术水平、骨水泥注入量等资料进行统计分析.结果 术后共36个椎体(31.6％)出现骨水泥渗漏,78个椎体无骨水泥渗漏.性别、年龄、伤椎解剖位置、穿刺路径的选择、主刀医师的专业技术水平与骨水泥渗漏无相关性(P＞0.05);而一次性治疗椎体的个数、术式的选择、椎体的骨折情况、骨水泥注入量与骨水泥渗漏有相关性(P＜0.05).结论 椎体成形术后骨水泥渗漏与一次性治疗椎体的个数、术式的选择、椎体的骨折情况、骨水泥注入量有关.掌握正确的操作方法和适应证、注入适量的高黏度骨水泥量,可以减少骨水泥渗漏的发生.