经皮椎体成形术骨水泥渗漏的回顾性分析
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摘要
目的分析经皮椎体成形术(PVP)骨水泥渗漏的特点,探讨PVP骨水泥渗漏的风险因素。方法选择我院2016年1月～2018年12月行PVP治疗的111例骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)患者(147个椎体),骨折椎体所在节段术前均行DR、三维CT及MRI检查,术后行DR或/和三维CT复查。分析性别、年龄、椎体位置及椎体损伤情况(裂隙征、骨皮质损伤)对骨水泥渗漏率的影响,及骨水泥渗漏的特点。结果性别、年龄及椎体位置对骨水泥渗漏率的影响无统计学意义;椎体裂隙征合并骨皮质损伤骨水泥渗漏率最高,骨皮质损伤骨水泥渗漏数量最多,差异均有统计学意义(P<0.001);骨水泥椎旁渗漏发生率最高,椎间盘渗漏次之,椎管内渗漏率最低,差异有统计学意义(P=0.005)。结论椎体损伤是PVP治疗骨水泥渗漏发生的重要原因,术前仔细观察椎体损伤的影像学特点对预防骨水泥渗漏具有重要意义。
Objective To analyze the characteristics of percutaneous vertebroplasty(PVP) bone cement leakage, and to investigate the risk factors of PVP bone cement leakage. Methods A total of 111 patients(147 vertebral body) with osteoporotic vertebral compression fractures(osteoporotic vertebral compression fracture, OVCF) who were treated with PVP in our hospital from January 2016 to December 2018 were selected. Preoperative DR, 3D CT and MRI examinations were performed for all vertebral segments with fracture, and postoperative DR or 3D CT reexaminations were performed. The effects of gender, age, vertebral body position and vertebral body injury(fissure sign, cortical bone injury) on the rate of bone cement leakage and the characteristics of bone cement leakage were analyzed. Results Gender, age and vertebral body position had no significant effect on the bone cement leakage rate. Vertebral fissure sign combined with cortical injury was related with the highest rate of cement leakage, and cortical injury was related with the highest amount of cement leakage, and the differences were statistically significant(P<0.001). The incidence of bone cement pervertebral leakage was the highest, followed by intervertebral disc leakage and intraspinal leakage in sequence. The difference was statistically significant(P=0.005).Conclusion Vertebral body injury is an important cause of bone cement leakage in PVP treatment. Careful observation of the imaging characteristics of preoperative vertebral body injury is of great significance in prevention of bone cement leakage.
Objective To analyze the characteristics of percutaneous vertebroplasty(PVP) bone cement leakage, and to investigate the risk factors of PVP bone cement leakage. Methods A total of 111 patients(147 vertebral body) with osteoporotic vertebral compression fractures(osteoporotic vertebral compression fracture, OVCF) who were treated with PVP in our hospital from January 2016 to December 2018 were selected. Preoperative DR, 3D CT and MRI examinations were performed for all vertebral segments with fracture, and postoperative DR or 3D CT reexaminations were performed. The effects of gender, age, vertebral body position and vertebral body injury(fissure sign, cortical bone injury) on the rate of bone cement leakage and the characteristics of bone cement leakage were analyzed. Results Gender, age and vertebral body position had no significant effect on the bone cement leakage rate. Vertebral fissure sign combined with cortical injury was related with the highest rate of cement leakage, and cortical injury was related with the highest amount of cement leakage, and the differences were statistically significant(P<0.001). The incidence of bone cement pervertebral leakage was the highest, followed by intervertebral disc leakage and intraspinal leakage in sequence. The difference was statistically significant(P=0.005).Conclusion Vertebral body injury is an important cause of bone cement leakage in PVP treatment. Careful observation of the imaging characteristics of preoperative vertebral body injury is of great significance in prevention of bone cement leakage.
引文
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[13]Rodrigues DM,Cunha Machado DP,Campainha Fernandes SA,et al.Pulmonary cement embolism following balloon kyphoplasty:the impact of a procedural complication in a new era for lung cancer management[J].Mol Clin Oncol,2019,10(2):299-303.
[14]Filippiadis DK,Marcia S,Masala S,et al.Percutaneous vertebroplasty and kyphoplasty:current status,new developments and old controversies[J].Cardiovasc Intervent Radiol,2017,40(12):1815-1823.
[15]Zhan Y,Jiang J,Liao H,et al.Risk factors for cement leakage after vertebroplasty or kyphoplasty:a meta-analysis of published evidence[J].World Neurosurg,2017,101:633-642.
[16]姚玉龙,程子韵,张磊磊,等.经皮椎体成形术后椎管内骨水泥渗漏的回顾性研究[J].中国矫形外科杂志,2016,23(24):2209-2213.
[17]王俊.椎体内裂隙样变对经皮椎体后凸成形术疗效的影响[J].临床医药文献杂志,2015,32(2):6614-6615.
[2]Zhu SY,Zhong ZM,Wu Q,et al.Risk factors for bone cement leakage in percutaneous vertebroplasty:a retrospective study of four hundred and eighty five patients[J].Int Orthop,2016,40(6):1205-1210.
[3]Claren?on F,Fahed R,Gabrieli J,et al.Safety and clinical effectiveness of percutaneous vertebroplasty in the elderly(≥80 years)[J].Eur Radiol,2016,26(7):2352-2358.
[4]Kida K,Tani T,Kawazoe T,et al.Thoracic radicular pain caused by extravertebral gas and fluid collections associated with osteoporotic vertebral fracture containing a vacuum cleft[J].Case Rep Orthop,2019,2019:4284217.
[5]印平,马远征,马迅,等.骨质疏松性椎体压缩性骨折的治疗指南[J].中国骨质疏松杂志,2015,6(21):643-648.
[6]王翀妍,单治,陈欢欢,等.椎基静脉孔与椎体内裂隙相通可能是后凸成形术骨水泥渗漏的危险因素[J].中华骨科杂志,2014,4(34):373-379.
[7]Corcos G,Dbjay J,Mastier C,et al.Cement leakage in percutaneous vertebroplasty for spinal metastases[J].Spine,2014,39:E332-E338.
[8]Lee HJ,Park J,Lee IW,et al.Clinical,radiographic,and morphometric risk factors for adjacent and remote vertebral compression fractures over a minimum follow-up of 4 years after percutaneous vertebroplasty for osteoporotic vertebral compression fractures:novel threedimensional voxel-based morphometric analysis[J].World Neurosurg,2019,22:30114-30117.
[9]Wang F,Wang LF,Miao DC,et al.Which one is more effective for the treatment of very severe osteoporotic vertebral compression fractures:PVP or PKP[J].J Pain Res,2018,11:2625-2631.
[10]Mansoorinasab M,Abdolhoseinpour H.A review and update of vertebral fractures due to metastatic tumors of various sites to the spine:percutaneous vertebroplasty[J].Interv Med Appl Sci,2018,10(1):1-6.
[11]Yevich S,Tselikas L,Gravel G,et al.Percutaneous cement injection for the palliative treatment of osseous metastases:a technical review[J].Semin Intervent Radiol,2018,35(4):268-280.
[12]Ko BS,Cho KJ,Park JW.Early adjacent vertebral fractures after balloon kyphoplasty for osteoporotic vertebral compression fractures[J].Asian Spine J,2019,13(2):210-215.
[13]Rodrigues DM,Cunha Machado DP,Campainha Fernandes SA,et al.Pulmonary cement embolism following balloon kyphoplasty:the impact of a procedural complication in a new era for lung cancer management[J].Mol Clin Oncol,2019,10(2):299-303.
[14]Filippiadis DK,Marcia S,Masala S,et al.Percutaneous vertebroplasty and kyphoplasty:current status,new developments and old controversies[J].Cardiovasc Intervent Radiol,2017,40(12):1815-1823.
[15]Zhan Y,Jiang J,Liao H,et al.Risk factors for cement leakage after vertebroplasty or kyphoplasty:a meta-analysis of published evidence[J].World Neurosurg,2017,101:633-642.
[16]姚玉龙,程子韵,张磊磊,等.经皮椎体成形术后椎管内骨水泥渗漏的回顾性研究[J].中国矫形外科杂志,2016,23(24):2209-2213.
[17]王俊.椎体内裂隙样变对经皮椎体后凸成形术疗效的影响[J].临床医药文献杂志,2015,32(2):6614-6615.