椎体强化术骨水泥渗漏的危险因素
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摘要
[目的]探讨椎体强化术骨水泥发生渗漏的危险因素。[方法]回顾性分析本院2016年12月～2018年02月收治的165例行椎体强化术治疗的患者,依据术后发生渗漏与否分为:渗漏组和无渗漏组。记录患者年龄、性别、骨密度、骨折节段、椎体压缩程度、骨折椎体的后壁及终板完整性、术式选择、手术入路、手术穿刺方法、注入骨水泥的体积等资料,并进行统计分析。[结果] 165例患者中,54例发生渗漏,111例未观察到渗漏。两组患者在年龄、性别、骨密度、骨折节段、手术入路、手术穿刺方法方面差异无统计学意义(P>0.05),而两组在椎体后壁完整与否、椎体终板完整与否、手术方式、椎体压缩程度、注入骨水泥的体积方面差异有统计学意义(P<0.05)。二分变量逻辑回归分析表明:骨水泥渗漏与否与椎体后壁完整与否、椎体终板完整与否、术式选择、椎体压缩程度有显著相关性(P<0.05)。[结论]椎体后壁完整与否、椎体终板完整与否、术式选择、椎体压缩程度是椎体强化术骨水泥渗漏的危险因素。
[Objective] To explore the risk factors of bone cement leakage in vertebral augmentation. [Methods] A retrospective study was done on 165 patients who underwent vertebral augmentation in our hospital from December 2016 to February 2018. Based on whether or not bone cement leakage happened, the patients were divided into two groups, and the data, including the age, gender, bone density, fracture location, extent of vertebral compression, posterior wall and endplate integrity of the fractured vertebral body, surgical methods and approach selected, surgical puncture method, as well as volume of bone cement injected, were statistically analyzed between the two groups. [Results] Among 165 patients, 54 patients proved of bone cement leakage, while the remaining 111 patients were of non-leakage. Comparing the two groups, there were no statistically significant differences between them regarding to age, gender, bone density, fracture location, surgical approach, and surgical puncture(P>0.05). However, statistically significant differences were determined in the posterior wall integrity of the fractured vertebral body, the vertebral endplate integrity, the surgical methods, the extent of vertebral compression, and the volume of bone cement injected between them(P<0.05), which might be risk factors related to bone cement leakage. In addition, the binary logistic regression analysis revealed that the bone cement leakage was significantly related to the posterior wall integrity of the fractured vertebral body, the vertebral endplate integrity, surgical methods selected, and the extent of vertebral compression(P<0.05).[Conclusion] The posterior wall integrity of the fractured vertebral body, the vertebral endplate integrity, surgical methods used, and the extent of vertebral compression are the risk factors for bone cement leakage during vertebral augmentation.
[Objective] To explore the risk factors of bone cement leakage in vertebral augmentation. [Methods] A retrospective study was done on 165 patients who underwent vertebral augmentation in our hospital from December 2016 to February 2018. Based on whether or not bone cement leakage happened, the patients were divided into two groups, and the data, including the age, gender, bone density, fracture location, extent of vertebral compression, posterior wall and endplate integrity of the fractured vertebral body, surgical methods and approach selected, surgical puncture method, as well as volume of bone cement injected, were statistically analyzed between the two groups. [Results] Among 165 patients, 54 patients proved of bone cement leakage, while the remaining 111 patients were of non-leakage. Comparing the two groups, there were no statistically significant differences between them regarding to age, gender, bone density, fracture location, surgical approach, and surgical puncture(P>0.05). However, statistically significant differences were determined in the posterior wall integrity of the fractured vertebral body, the vertebral endplate integrity, the surgical methods, the extent of vertebral compression, and the volume of bone cement injected between them(P<0.05), which might be risk factors related to bone cement leakage. In addition, the binary logistic regression analysis revealed that the bone cement leakage was significantly related to the posterior wall integrity of the fractured vertebral body, the vertebral endplate integrity, surgical methods selected, and the extent of vertebral compression(P<0.05).[Conclusion] The posterior wall integrity of the fractured vertebral body, the vertebral endplate integrity, surgical methods used, and the extent of vertebral compression are the risk factors for bone cement leakage during vertebral augmentation.
引文
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[9]Meng B,Qian M,Xia SX,et al.Biomechanical characteristics of cement/gelatin mixture for prevention of cement leakage in vertebral augmentation[J].Eur Spine J,2013,22(10):2249-2255.
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[11]Georgy BA.Feasibility,safety and cement leakage in vertebroplasty of osteoporotic and malignant compression fractures using ultraviscous cement and hydraulic delivery system[J].Pain Physician,2012,15(3):223-228.
[12]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.
[13]McCall T,Cole C,Dailey A.Vertebroplasty and kyphoplasty:a comparative review of efficacy and adverse events[J].Curr Rev Musculoskelet Med,2008,1(1):17-23.
[14]Baumann C,Fuchs H,Kiwit J,et al.Complications in percutaneous vertebroplasty associated with puncture or cement leakage[J].Cardiovasc Intervent Radiol,2007,30(2):161-168.
[15]Li S,Wang C,Shan Z,et al.Trabecular Microstructure and Damage Affect Cement Leakage From the Basivertebral Foramen During Vertebral Augmentation[J].Spine(Phila Pa 1976),2017,42(16):E939-E948.
[16]Fu Z,Hu X,Wu Y,et al.Is There a Dose-Response Relationship of Cement Volume With Cement Leakage and Pain Relief After Vertebroplasty[J].Dose-Response,2016,14(4):500980290.
[17]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.
[18]Martin DJ,Rad AE,Kallmes DF.Prevalence of extravertebral cement leakage after vertebroplasty:procedural documentation versus CT detection[J].Acta Radiol,2012,53(5):569-572.
[2]Hulme PA,Krebs J,Ferguson SJ,et al.Vertebroplasty and kyphoplasty:a systematic review of 69 clinical studies[J].Spine(Phila Pa 1976),2006,31(17):1983-2001.
[3]Yan L,Jiang R,He B,et al.A comparison between unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty[J].Spine(Phila Pa 1976),2014,39(26Spec No.):B19-B26.
[4]Genant HK,Wu CY,van Kuijk C,et al.Vertebral fracture assessment using a semiquantitative technique[J].J Bone Mineral Res,1993,8(9):1137-1148.
[5]Hiwatashi A,Ohgiya Y,Kakimoto N,et al.Cement leakage during vertebroplasty can be predicted on preoperative MRI[J].AJR Am J Roentgenol,2007,188(4):1089-1093.
[6]Ren H,Shen Y,Zhang YZ,et al.Correlative factor analysis on the complications resulting from cement leakage after percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture[J].J Spinal Disord Tech,2010,23(7):E9-E15.
[7]Nieuwenhuijse MJ,Van Erkel AR,Dijkstra PD.Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures:identification of risk factors[J].Spine J,2011,11(9):839-848.
[8]Wu ZX,Wei L,Hu YY,et al.Staged-injection procedure to prevent cement leakage during vertebroplasty:an in vitro study[J].Spine(Phila Pa 1976),2007,32(22):2437-2442.
[9]Meng B,Qian M,Xia SX,et al.Biomechanical characteristics of cement/gelatin mixture for prevention of cement leakage in vertebral augmentation[J].Eur Spine J,2013,22(10):2249-2255.
[10]Georgy BA.Clinical experience with high-viscosity cements for percutaneous vertebral body augmentation:occurrence,degree,and location of cement leakage compared with kyphoplasty[J].AJNR Am J Neuroradiol,2010,31(3):504-508.
[11]Georgy BA.Feasibility,safety and cement leakage in vertebroplasty of osteoporotic and malignant compression fractures using ultraviscous cement and hydraulic delivery system[J].Pain Physician,2012,15(3):223-228.
[12]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.
[13]McCall T,Cole C,Dailey A.Vertebroplasty and kyphoplasty:a comparative review of efficacy and adverse events[J].Curr Rev Musculoskelet Med,2008,1(1):17-23.
[14]Baumann C,Fuchs H,Kiwit J,et al.Complications in percutaneous vertebroplasty associated with puncture or cement leakage[J].Cardiovasc Intervent Radiol,2007,30(2):161-168.
[15]Li S,Wang C,Shan Z,et al.Trabecular Microstructure and Damage Affect Cement Leakage From the Basivertebral Foramen During Vertebral Augmentation[J].Spine(Phila Pa 1976),2017,42(16):E939-E948.
[16]Fu Z,Hu X,Wu Y,et al.Is There a Dose-Response Relationship of Cement Volume With Cement Leakage and Pain Relief After Vertebroplasty[J].Dose-Response,2016,14(4):500980290.
[17]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.
[18]Martin DJ,Rad AE,Kallmes DF.Prevalence of extravertebral cement leakage after vertebroplasty:procedural documentation versus CT detection[J].Acta Radiol,2012,53(5):569-572.