经皮椎体后凸成形术中骨水泥渗漏的相关因素分析

摘要

Objective To analyze the related factors of bone cement leakage in percutaneous kyphoplasty (PKP).Methods The 193 consecutive patients (269 vertebrae) who underwent PKP for treatment of osteoporosis vertebral compression fracture.These factors may affect the occurrence of cement leakage were assessed by univariate and multivariate analysis.According to the imaging examination ,the type of fracture was divided into 5 groups:type N 9 vertebrae (3.3%), type A 180 vertebrae (66.9%), type E 25 vertebrae (9.3%), type H 39 vertebrae(14.5%) and type K 16 vertebrae ( 5.9%).According to the degree of vertebral compression , the patients were divided into 3 groups:mild compression 188 vertebrae (69.9%), moderate compression 54 vertebrae (20.1%) and severe compression 27 vertebrae(10.0%).Results Bone cement leakage was detected in 175 vertebrae (65.0%),of which the basivertebral vein (74 vertebrae, 42.3%) and the segmental vein (70 vertebrae, 40%) were the most common leakage , and cortical defect ( 34 vertebrae , 19.4%) and intradiscal leakage ( 58 vertebrae , 33.1%) were lower than above.Univariate analysis showed that the type of fracture and the degree of vertebral compression had statistical significance of cement leakage (P＜0.05).The degree of vertebral compression was protective factor of the cement leakage in segmental vein leakage in multivariate analysis , and the type of fracture and the degree of vertebral compression both were important factors of cortical defect and intradiscal leakage ( P＜0.05 ).Conclusions Type of fracture and degree of vertebral compression are important factors of bone cement extravasation.%目的 探讨经皮椎体后凸成形术(PKP)中影响骨水泥渗漏的相关因素.方法 对193例骨质疏松性椎体压缩骨折(OVCF)患者(269椎)行PKP治疗.对可能影响骨水泥渗漏的因素进行单变量及多变量分析.根据影像学检查将骨折类型分为:N型9椎(3.3%),A型180椎(66.9%),E型25椎(9.3%),H型39椎(14.5%),K型16椎(5.9%).根据椎体压缩程度分为:轻度压缩188椎(69.9%),中度压缩54椎(20.1%),重度压缩27椎(10.0%).结果 175椎(65.0%)发生骨水泥渗漏,其中椎基静脉型(74椎,42.3%)和节段静脉型(70椎,40%)发生率较高,皮质缺损型(34椎,19.4%)和椎间盘内渗漏型(58椎,33.1%)发生率较低.单变量分析结果显示,骨折类型及椎体压缩程度与骨水泥渗漏有明显的相关性(P<0.05).多变量分析结果显示,对于节段静脉型渗漏,椎体压缩程度是重要的保护因素,而对于皮质缺损型和椎间盘内渗漏型渗漏,骨折类型及椎体压缩程度都是重要的影响因素(P<0.05).结论 骨折类型和椎体压缩程度是骨水泥渗漏的重要影响因素.