PVP术中骨水泥渗漏的危险因素分析
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摘要
目的分析经皮椎体成形术(PVP)中骨水泥渗漏的危险因素及预防措施。方法选取2015-04-2017-04我院收治的骨质疏松椎体压缩性骨折(OVCF)患者120例为研究对象,均行PVP术,按术中是否出现骨水泥渗漏分为观察组(骨水泥渗漏,45例)、对照组(无骨水泥渗漏,75例),记录骨水泥渗漏位置,对比两组穿刺点、骨密度、骨折压缩程度、骨水泥注入量、脊柱后凸Cobb角、椎体有无裂隙征、椎基静脉孔相通等资料,分析OVCF患者PVP术后发生骨水泥渗漏的影响因素及。结果本研究中120例OVCF患者共45例出现骨水泥渗漏,骨水泥渗漏发生率为37.50%;骨水泥渗漏部位主要为椎旁静脉(25.00%)、椎管内硬膜外(5.83%)、椎间盘(5.00%);观察组骨密度-(0.26±0.07)、骨水泥注入量(3.69±0.10)ml、脊柱后凸Cobb角(19.46±1.23)°、穿刺点单侧62.22%、骨水泥注射时期粥状期17.78%、椎体裂隙征28.89%、椎基静脉孔相通17.78%与对照组对比差异有统计学意义(P<0.05);多因素分析显示,脊柱后凸角、骨水泥注射时期、椎体裂隙征、椎基静脉孔相通是导致PVP术中骨水泥渗漏的独立危险因素(P<0.05)。结论 OVCF患者在PVP术中可能因脊柱后凸Cobb角、骨水泥注射时期、椎体裂隙征、椎基静脉孔相通等因素影响而发生骨水泥渗漏,需根据患者情况选择个体化治疗方案。
Objective To analyze the risk factors and preventive measures of bone cement leakage in percutaneous vertebroplasty(PVP). Methods From April 2015 to April 2017, 120 patients with osteoporotic vertebral compression fractures(OVCF) treated in our hospital were selected in the study and treated with PVP. According to whether there was bone cement leakage during operation, the patients were divided into the observation group(bone cement leakage, n =45) and the control group(no bone cement leakage, n =75). The location of bone cement leakage was recorded, and the data of puncture points, bone density, fracture compression degree, bone cement injection volume, Cobb angle of posterior vertebral column, the vertebral body with or without fracture and connection of vertebral vein orifice were compared between the two groups. The influencing factors and risk factors of bone cement leakage after PVP in OVCF patients were analyzed. Results There were 45 cases of bone cement leakage in the 120 cases of OVCF patients, the bone cement leakage rate was 37.50%. The main sites of bone cement leakage were paravertebral vein(25%), epidural(5.83%) and intervertebral disc(5%). The bone density, bone cement injection volume, Cobb angle of posterior vertebral column, unilateral puncture point, bone cement injection period gruel, vertebral fissure sign and the connection of vertebral vein orifice were-(0.26±0.07),(3.69±0.10) ml,(19.46±1.23)°, 62.22%, 17.78%, 28.89%and 17.78% in the observation group, which were significantly different from those in the control group(P <0.05). Multivariate Logistic regression analysis showed that Cobb angle of posterior vertebral column, bone cement injection period, vertebral body with or without fractures and the connection of vertebral vein orifice were the independent risk factors of bone cement leakage during PVP(P<0.05). Conclusions OVCF patients may have bone cement leakage due to Cobb angle of posterior vertebral column, bone cement injection period, vertebral fracture syndrome,the connection of vertebral vein orifice and other factors during PVP, therefore the individualized treatments are selected according to the patients' condition.
Objective To analyze the risk factors and preventive measures of bone cement leakage in percutaneous vertebroplasty(PVP). Methods From April 2015 to April 2017, 120 patients with osteoporotic vertebral compression fractures(OVCF) treated in our hospital were selected in the study and treated with PVP. According to whether there was bone cement leakage during operation, the patients were divided into the observation group(bone cement leakage, n =45) and the control group(no bone cement leakage, n =75). The location of bone cement leakage was recorded, and the data of puncture points, bone density, fracture compression degree, bone cement injection volume, Cobb angle of posterior vertebral column, the vertebral body with or without fracture and connection of vertebral vein orifice were compared between the two groups. The influencing factors and risk factors of bone cement leakage after PVP in OVCF patients were analyzed. Results There were 45 cases of bone cement leakage in the 120 cases of OVCF patients, the bone cement leakage rate was 37.50%. The main sites of bone cement leakage were paravertebral vein(25%), epidural(5.83%) and intervertebral disc(5%). The bone density, bone cement injection volume, Cobb angle of posterior vertebral column, unilateral puncture point, bone cement injection period gruel, vertebral fissure sign and the connection of vertebral vein orifice were-(0.26±0.07),(3.69±0.10) ml,(19.46±1.23)°, 62.22%, 17.78%, 28.89%and 17.78% in the observation group, which were significantly different from those in the control group(P <0.05). Multivariate Logistic regression analysis showed that Cobb angle of posterior vertebral column, bone cement injection period, vertebral body with or without fractures and the connection of vertebral vein orifice were the independent risk factors of bone cement leakage during PVP(P<0.05). Conclusions OVCF patients may have bone cement leakage due to Cobb angle of posterior vertebral column, bone cement injection period, vertebral fracture syndrome,the connection of vertebral vein orifice and other factors during PVP, therefore the individualized treatments are selected according to the patients' condition.
引文
[1]刘波.液压输送骨水泥PVP与PKP治疗骨质疏松性椎体压缩骨折的比较研究[J].颈腰痛杂志,2017,38(2):169-173.
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[4]郭锦明,严宏生,刘俊,等.牵引复位结合“双同法”PVP治疗老年创伤性椎体压缩性骨折[J].颈腰痛杂志,2015,36(2):128-130.
[5]吴金伟,邹伟民,吕海,等.骨水泥在骨质疏松性椎体骨折线内弥散情况对椎体成形术疗效的影响[J].医学临床研究,2017,34(5):846-849.
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[7]郑毓嵩,张勇,林金丁,等.椎体成形术骨水泥渗漏的相关危险因素分析[J].中华创伤杂志,2015,31(4):312-316.
[8]程跃,周德春,王美福,等.经皮椎体后凸成形术骨水泥渗漏的相关因素研究[J].中国现代医学杂志,2016,26(14):125-128.
[9]姚海燕,李青,赵成毅,等.PVP术中椎间盘骨水泥渗漏的危险因素及对策[J].中国骨科临床与基础研究杂志,2016,8(3):133-140.
[10]张鹤令,李凌伟.椎内裂隙征和椎基静脉孔相通与PKP术后骨水泥渗漏的相关性分析[J].重庆医学,2014,44(35):5030-5032.
[2]任虎,冯涛,张宏,等.经皮椎体后凸成形术骨水泥渗漏相关因素[J].中国老年学杂志,2016,36(9):2203-2205.
[3]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,2015,21(6):643-648.
[4]郭锦明,严宏生,刘俊,等.牵引复位结合“双同法”PVP治疗老年创伤性椎体压缩性骨折[J].颈腰痛杂志,2015,36(2):128-130.
[5]吴金伟,邹伟民,吕海,等.骨水泥在骨质疏松性椎体骨折线内弥散情况对椎体成形术疗效的影响[J].医学临床研究,2017,34(5):846-849.
[6]王素春,施建东,陆爱清,等.椎基静脉孔及椎体静脉解剖在椎体成形术中的意义[J].中国临床解剖学杂志,2015,33(6):646-650.
[7]郑毓嵩,张勇,林金丁,等.椎体成形术骨水泥渗漏的相关危险因素分析[J].中华创伤杂志,2015,31(4):312-316.
[8]程跃,周德春,王美福,等.经皮椎体后凸成形术骨水泥渗漏的相关因素研究[J].中国现代医学杂志,2016,26(14):125-128.
[9]姚海燕,李青,赵成毅,等.PVP术中椎间盘骨水泥渗漏的危险因素及对策[J].中国骨科临床与基础研究杂志,2016,8(3):133-140.
[10]张鹤令,李凌伟.椎内裂隙征和椎基静脉孔相通与PKP术后骨水泥渗漏的相关性分析[J].重庆医学,2014,44(35):5030-5032.