经皮椎体成形术后骨水泥渗漏的CT评价  

Cement leakages in percutaneous vertebroplasty： analysis of postoperative computed tomography

作　　者：铁镔[1] 何仕诚[1] 滕皋军[1] 方文[1] 郭金和[1] 邓钢[1] 朱光宇[1] 

机构地区：[1]东南大学医学院医学影像与核医学研究所东南大学附属中大医院放射科,南京210009

出　　处：《中华医学杂志》2012年第5期299-302,共4页National Medical Journal of China

基　　金：江苏省卫生厅2010年度科研项目（H201033）

摘　　要：目的 探讨经皮椎体成形术（ PVP）治疗骨质疏松椎体压缩骨折（OVCF）和椎体转移瘤（VM）骨水泥渗漏的影响因素.方法 收集2007年5月至2011年1月我院应用PVP治疗OVCF和VM且CT随访资料完整356例653节椎体,其中OVCF组251例共438节椎体,VM组105例共215节椎体.术前CT评估是否有椎体骨皮质碎裂或破坏,术后3d内CT复查观察骨水泥分布和渗漏情况.比较两组骨水泥注入量和各型渗漏的差异,评估骨水泥渗漏与骨皮质裂缝或破坏的相关性.结果 所有PVP操作均成功,平均注入骨水泥量OVCF组（5.0 ±2.0）ml,VM组（4.0±1.7）ml（P＜0.05）；术后CT检查证实椎体周围骨水泥渗漏OVCF组有93节（21.23％）,VM组有62节（28.8％）,两组比较差异有统计学意义（P＜0.05）,但均无临床症状；椎旁静脉渗漏OVCF组有12节,VM组26节（P＜0.01）；椎间盘渗漏OVCF组有58节,VM组有16节（P =0.025）；术前终板碎裂与椎间盘渗漏密切有相关性,OVCF组（r=0.29）,VM（r=0.31）；术前椎体周围骨皮质碎裂或破坏与椎旁软组织渗漏亦有一定的相关性,OVCF组（r=0.14）,VM（r =0.27）.结论 PVP治疗OVCF与VM后骨水泥少量渗漏是安全的；VM骨水泥渗漏发生率显著高于OVCF,前者更容易发生椎静脉渗漏；终板和周围骨皮质碎裂或破坏是椎间盘和椎旁软组织渗漏的主要原因.Objective To evaluate the influencing factors of cement leakage in vertebroplasty for the treatment of osteoporosis vertebral compression fracture （OVCF） and vertebral metastases （VM）.Methods Retrospective analysis was conducted for 653 vertebrae in 356 patients undergoing vertebroplasty at our hospital from May 2007 to January 2011.251 cases had 438 vertebrae with painful OVCF while 105 cases had 215 vertebrae with VM.Pre-operative computed tomography （CT） was performed to determine the presence of cortical defects or osteolysis and within 3 days after PVP to observe the distribution of polymethylmethacrylate （PMMA） in vertebrae and whether leakage occurred.Volume of PMMA injected into each vertebral body and types of cement leakage were compared between the OVCF and VM groups by Z test or x2.The correlation between cortical defects and cement leakages around vertebrae was assessed with Pearson correlation coefficient. Results The successful rate of PVP was 100%. The mean volume of PMMA injected into each vertebra was （5.0 ±2.0） ml and （4.0 ± 1.7） ml in the OVCF and VM groups respectively （P 〈0.05）.Asymptomatic PMMA leakage was demonstrated by CT in 93 vertebrae （21.2%）in the OVCF group and in 53 vertebrae （28.8% ） in the VM group respectively （ P 〈 0.05 ）.Cement leakages into disk were found in 58 vertebrae in the OVCF group and 16 vertebrae in the VM group respectively （P =0.025）.Cement leakages into paravertebral vein were found in 12 vertebrae in the OVCF group and 26 vertebrae in the VM group respectively （P 〈 0.0001 ）.Correlation was found between cortical defects and cement leakage into paravertebral soft tissues in the OVCF group （r =0.14） or in the VM group （ r =0.27）,between end-plate defects and cement leakage into disk in the OVCF group （ r =0.29） or in the VM group （r =0.31 ）.Conclusion As a common occurrence in vertebroplasty,cement extravasation is well-tolerated in most patients.It occurs more frequently in the patients withV

关 键 词：骨质疏松 肿瘤转移 脊柱骨折 

分 类 号：R687.3[医药卫生—骨科学]