经皮椎体后凸成形术并发症危险因素的探讨  

Investigation on the risk factors associated with percutaneous kyphoplasty

作　　者：李朝顶[1,2,3] 杨六中[1] 沈金虎[1] 王喜安[1] 惠正广[1] 杨惠林[2] 

机构地区：[1]南京中医药大学附属徐州医院骨科,江苏徐州221000 [2]苏州大学第一附属医院骨科,江苏苏州215006 [3]皖南医学院附属弋矶山医院骨科,安徽芜湖241001

出　　处：《中华疾病控制杂志》2012年第11期979-981,共3页Chinese Journal of Disease Control & Prevention

基　　金：安徽省科技计划项目(08020303078);安徽省教育厅自然科学研究项目(KJ2008A09ZC)

摘　　要：目的探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)骨水泥外渗并发症的影响因素,为临床治疗和预防提供科学依据。方法采用回顾性调查方法,收集PKP治疗的58例(97个椎体)椎体骨质疏松性骨折(osteoporotic vertebral compression fracture,OVCF)患者的临床资料,多因素Logistic回归分析骨水泥渗漏的影响因素。结果所有患者术中均未发生球囊破裂、神经以及脊髓损伤,均对手术完全耐受。对58例患者进行6～24个月的随访,平均随访时间为(14.5±5.5)个月。患者经治疗后,VAS评分、椎体前缘及Cobb角高度均明显改善(均有P<0.001)。采用多因素Logistic回归分析显示,骨水泥注入量多(OR=7.235,P<0.001)、有椎体周壁破坏(OR=21.165,P<0.001)是导致骨水泥渗漏的主要影响因素。结论骨水泥注入量过多、有椎体周壁破坏是影响PKP手术发生骨水泥渗漏的主要危险因素,应当提高手术技术以预防骨水泥渗漏并发症的发生。Objective To investigate the risk factors of pereutaneous kyphoplasty （PKP） in vertebral compression fracture （VCF） associated with cement leakage. Methods The clinical data were reviewed in 58 patients （97 vertebrae） undergone PKP, multiple Logistic regression analysis was performed to evaluate the risk factors associated with cement leakage. Results All patients were tolerated to the operation and had no intra-operative damage to the nerves and spinal cord as well as bursting of the balloon. Follow-up of the total 58 subjects ranging from 6 to 24 months （ mean 14.5±5.5 ） suggested that the VAS scores, Cobb＇ s angle and height of the anterior plane deformity were different from the conditions before operation （ all P〈0. 001 ）. Multiple Logistic regression results showed that major complications were involved in exces- sively injected bone cement of per vertebra and damaged perinous bodies （ OR = 7. 235, P〈0. 001 ; OR = 21. 165, P〈 0. 001, respectively）. Conclusions Complicated leakage of PKP is primarily associated with excessive amount of injected cement during procedure and presence of peripheral vertebral wall damage, and great care and skills are important to prevent the complications.

关 键 词：椎体成形术 危险因素 LOGISTIC模型 

分 类 号：R274.1[医药卫生—中医骨伤科学] R181.2[医药卫生—中医学]