Kümmell病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 Kümmell disease

作　　者：唐本强[1] 陈学明[1] 崔利宾[1] 袁鑫[1] 刘亚东[1] 王永杰[1] Tang Benqiang;Chen Xueming;Cui Libin;Yuan Xin;Liu Yadong;Wang Yongjie(Department of Spinal Surgery,Beijing Luhe Hospital,Capital University,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,101149

出　　处：《中华骨科杂志》2020年第23期1592-1600,共9页Chinese Journal of Orthopaedics

摘　　要：目的探讨Kümmell病经皮椎体成形术骨水泥渗漏的危险因素。方法回顾性分析2015年11月至2019年6月行经皮椎体成形术治疗的309例(351节椎体)Kümmell病患者资料,男80例,女229例;年龄(75.1±7.5)岁(范围60~94岁)。记录患者年龄、性别、症状时间、Kümmell病分期、骨折位置(胸椎、腰椎)、有无椎体皮质连续性中断、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(团块样、海绵样)、骨水泥量、渗漏(是、否)、骨水泥渗漏类型。骨水泥渗漏类型分为:经椎基底静脉型、经骨皮质型、经椎体节段静脉型。应用单因素和多因素Logistic回归分析研究临床因素与骨水泥渗漏的关系。结果351节椎体,总渗漏发生率65.8%(231/351)。经椎基底静脉型渗漏率21.4%(75/351),经骨皮质型渗漏率37.6%(132/351),经椎体节段静脉型渗漏率22.8%(80/351)。多因素Logistic回归分析结果显示与渗漏相关的因素包括:椎体皮质连续性中断、存在椎基底静脉孔、骨水泥形态;与椎基底静脉型渗漏相关的因素包括:存在椎基底静脉孔、骨水泥形态;与骨皮质型渗漏相关的因素包括:椎体皮质连续性中断、骨水泥形态;与椎体节段静脉型渗漏相关的因素包括:存在椎基底静脉孔、骨水泥形态、骨水泥量、骨折位置。结论经皮椎体成形术治疗Kümmell病时发生骨水泥渗漏的危险因素包括椎体皮质连续性中断、存在椎基底静脉孔、骨水泥形态等。Objective To identify risk factors for cement leakage in percutaneous vertebroplasty (PVP) for Kümmell disease.Methods A total of 309 patients (351 levels) with Kümmell disease who underwent PVP between November 2015 and June 2019 were retrospectively reviewed. Age, gender, time of symptom onset, staging of Kümmell disease, fracture site(thoracic, lumbar), cortical disruption, type of fracture (wedge, biconcave, crush), fracture severity (mild, moderate, severe), intrusion of posterior wall, basivertebral foramen, puncture approach (unilateral, bilateral), cement distribution pattern (lumped, spongy), cement volume, cement leakage (yes, no) and cement leakage type were recorded. Cement leakage was classified into three types: through the basivertebral vein, through the cortical defect, and through the segmental vein. The data was analyzed by univariate and multivariate analysis to determine related factors of cement leakage in general and each type.Results The rate of overall leakage was 65.8% (231/351). The leakage rate of basivertebral vein type, cortical defect type, and segmental vein type was 21.4% (75/351), 37.6% (132/351) and 22.8% (80/351), respectively. Multivariate analysis showed that three significant factors related to leakage in general were cortical disruption, basivertebral foramen and cement distribution pattern. Significant factors related to basivertebral vein type leakage were basivertebral foramen and cement distribution pattern. Significant factors related to cortical defect type leakage were cortical disruption and cement distribution pattern. Significant factors related to segmental vein type leakage were basivertebral foramen, cement distribution pattern, cement volume and fracture site.Conclusion Risk factors of cement leakage in PVP for Kümmell disease include cortical disruption, basivertebral foramen and cement distribution pattern.

关 键 词：胸椎 腰椎 骨质疏松性骨折 椎体成形术 骨黏合剂 危险因素 

分 类 号：R687.3[医药卫生—骨科学]