年龄≥80岁骨质疏松性椎体压缩骨折患者经皮椎体成形术骨水泥渗漏的危险因素分析  

Risk factors for cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures in octogenarians

作　　者：崔利宾[1] 唐本强[1] 王彦辉[1] 许崧杰[1] 袁鑫[1] 刘亚东[1] 赵鹏[1] 陈学明[1] CUI Libin;TANG Benqiang;WANG Yanhui(Spine Surgery Department,Beijing Luhe Hospital,Capital Medical College,Beijing,101149,China)

机构地区：[1]首都医科大学附属北京潞河医院脊柱外科,北京市101149

出　　处：《中国脊柱脊髓杂志》2020年第6期530-538,共9页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨年龄≥80岁骨质疏松性椎体压缩骨折患者经皮椎体成形术骨水泥渗漏的危险因素。方法 :对2015年11月~2019年6月收治的236例(344节椎体)年龄≥80岁骨质疏松性椎体压缩骨折行经皮椎体成形术患者的临床资料进行回顾性分析。记录患者年龄、性别、病程(急性、亚急性、慢性)、有无外伤、伤椎位置(中胸段、下胸段、腰椎)、有无椎体皮质连续性中断、有无裂隙征、骨折形态(楔形、双凹、压缩)、骨折程度(轻度、中度、重度)、椎体后壁皮质是否突入椎管、是否发现椎基底静脉孔、穿刺方式(单侧、双侧)、骨水泥形态(弥散样、团块样)、骨水泥量、骨水泥渗漏类型。骨水泥渗漏类型分为:经椎基底静脉型(B型),经骨皮质型(C型)、经椎体节段静脉型(S型)。应用单因素和多因素Logistic回归分析研究各因素与各骨水泥渗漏类型的关系。结果:B型渗漏率28.5%(98/344);C型渗漏率24.4%(84/344);S型渗漏率34.3%(118/344)。多因素Logistic回归分析结果显示,与B型渗漏相关的因素(P<0.05)为骨水泥形态、是否发现椎基底静脉孔;与C型渗漏相关的因素(P<0.05)为有无椎体皮质连续性中断;与S型渗漏相关的因素(P<0.05)为骨水泥形态、是否发现椎基底静脉孔、裂隙征、骨折程度、椎体后壁皮质是否突入椎管、性别。结论:年龄≥80岁患者,不同类型骨水泥渗漏有各自的危险因素;分析骨水泥渗漏危险因素,或有助于降低渗漏发生率。Objectives:To identify risk factors for cement leakage in percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fractures(OVCFs)in octogenarians.Methods:A total of 236 patients aged at 80 or more who underwent PVP at 344 levels for OVCFs between November 2015 and June 2019 were retrospectively reviewed.Data included age,gender,onset of symptoms(acute,subacute,chronic),trauma,frac-ture level(mid-thoracic,lower thoracic,lumbar),cortical disruption,cleft sign,type of fracture(wedge,bicon-cave,crush),fracture severity(mild,moderate,severe),intrusion of posterior wall,basivertebral foramen,punc-ture approach(unilateral,bilateral),cement distribution pattern(trabecular,cleft),cement volume,type of ce-ment leakage was recorded.Cement leakage was classified into three types:through the basivertebral vein(Btype),through the cortical defect(C-type),through the segmental vein(S-type).The data were analyzed by uni-variate and multivariate analysis to determine related factors for B-type,C-type and S-type cement leakage.Results:The rate of B-type,C-type and S-type leakage was 28.5%(98/344),24.4%(84/344)and 34.3%(118/344),respectively.Multivariate analysis showed that two significant factors related to B-type leakage were ce-ment distribution pattern and basivertebral foramen.One significant factor related to C-type leakage was corti cal disruption.Six significant factors related to S-type leakage were cement distribution pattern,basivertebral foramen,cleft,fracture severity,intrusion of posterior wall and gender.Conclusions:In PVP for OVCFs in octogenarians,each different cement leakage has its own risk factors;Identification of risk factors for cement leakage might be helpful inreducing the rate of cement leakage.

关 键 词：骨质疏松性椎体压缩骨折 经皮椎体成形术 骨水泥渗漏 危险因素 

分 类 号：R683.2[医药卫生—骨科学] R619[医药卫生—外科学]