经皮椎体成形术治疗老年骨质疏松性胸腰椎压缩性骨折术中骨水泥渗漏的相关因素  

Factors related to bone cement leakage during percutaneous vertebroplasty for elderly osteoporotic thoracolumbar vertebral compression fractures

作　　者：王惠东[1] 姚方超 傅智轶[1] 吴玉杰[1] WANG Hui-dong;YAO Fang-chao;FU Zhi-yi;WU Yu-jie(Department of Orthopedics,Ninth People’s Hospital,Shanghai Jiao Tong University School ofMedecine,Shanghai 201900,China)

机构地区：[1]上海交通大学医学院附属第九人民医院骨科

出　　处：《脊柱外科杂志》2019年第3期192-197,共6页Journal of Spinal Surgery

摘　　要：目的 分析经皮椎体成形术(PVP)治疗老年骨质疏松性椎体压缩性骨折(OVCF)术中骨水泥渗漏的相关危险因素。方法 收集2015年1月—2017年12月采用PVP治疗的297例老年OVCF患者资料。采用logistic回归法分析年龄、性别、骨折部位、椎体压缩程度、椎体终板/后壁完整性、骨折节段数、骨水泥注射量与骨水泥渗漏(椎间盘、软组织、血管内、椎管内及混合渗漏)的关系。结果 术中共166例发生骨水泥渗漏,渗漏率55.9%。二元logistic回归分析示骨水泥剂量高是骨水泥渗漏的唯一危险因素。多元logistic回归分析示椎体压缩程度高和骨折节段数多是椎间盘渗漏的危险因素;骨水泥注射量大和椎体压缩程度高是软组织渗漏的危险因素;女性和年龄较低是血管内渗漏的危险因素;骨水泥注射量大和椎体终板/后壁破裂是椎管内渗漏的危险因素。结论 不同的危险因素导致PVP术中不同的渗漏类型。明确不同危险因素与各渗漏类型间的相互关系有利于防止骨水泥渗漏的发生。Objective To analyze the factors related to bone cement leakage during percutaneous vertebroplasty(PVP)for elderly osteoporotic thoracolumbar vertebral compression fractures(OVCF).Methods The data of 297 elderly OVCF patients treated with PVP from January 2015 to December 2017 were collected.Logistic regression method was used to analyze the relationship between the factors(age,gender,fracture site,vertebral compression degree,integrity of vertebral endplate/posterior wall,number of fracture segments,amount of cement injection)and bone cement leakage(intervertebral disc,soft tissue,intravascular,spinal canal and mixed leakage).Results There were 166 patients with bone cement leakage,and the leakage rate was 55.9%.The results of bivariate logistic regression analysis showed that the high dose of bone cement was the only risk factor for bone cement leakage.The results of multivariate logistic regression analysis showed that the high degree of vertebral compression and the multilevel fracture were risk factors for the intervertebral disc leakage of bone cement.The high dose of bone cement and the high degree of vertebral compression were risk factors for soft tissue leakage of bone cement.Female and younger age were risk factors for intravascular leakage of bone cement.The high dose of bone cement and fracture of vertebral endplate/posterior wall were the risk factors for intraspinal leakage of bone cement.Conclusion Bone cement leakage during PVP is the result of many factors,and different risk factors in PVP operation may lead to different leakage types.To clarify the relationship between different risk factors and different types of leakage is helpful to prevent the occurrence of cement leakage.

关 键 词：胸椎 腰椎 骨折 压缩性 骨质疏松 椎体成形术 骨代用品 手术中并发症 

分 类 号：R683.2[医药卫生—骨科学]