经皮椎体强化后骨水泥椎间盘渗漏与治疗前MRI发现的相关性  

Correlation between preoperative magnetic resonance imaging findings and bone cement leakage after percutaneous vertebral augmentation

作　　者：侯万星 李洪伟 郑欣 朱先任 Hou Wanxing;Li Hongwei;Zheng Xin;Zhu Xianren(Department of Orthopedics,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属医院骨科,江苏省徐州市221006

出　　处：《中国组织工程研究》2022年第4期504-509,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:有研究表明,骨质疏松性椎体压缩骨折患者伴随的终板损伤与经皮椎体强化后骨水泥椎间盘渗漏有关。目的:探讨经皮椎体强化后骨水泥椎间盘渗漏与术前MRI发现的相关性,分析终板骨折及邻近椎间盘损伤对骨水泥椎间盘渗漏的影响。方法:选择2018年9月至2019年12月徐州医科大学附属医院收治的单节段骨质疏松性椎体压缩骨折患者182例,其中110例接受经皮椎体后凸成形骨水泥注射治疗,72例接受经皮椎体成形骨水泥注射治疗。根据术前MRI片评估骨折椎体相邻椎间盘损伤和终板骨折情况。根据术后是否出现椎间盘骨水泥渗漏分为渗漏组(n=32)和无渗漏组(n=150),对患者年龄、性别、手术椎体部位、手术方式、终板骨折情况、相邻椎间盘损伤情况与骨水泥椎间盘渗漏的相关性进行单因素分析,再进行多因素的二元logistics回归模型分析。研究经徐州医科大学附属医院医学伦理委员会批准。结果与结论:(1)182例患者中,术前63例存在终板骨折,98例存在邻近椎间盘损伤;所有患者中,32例椎体强化后发生骨水泥椎间盘渗漏,终板骨折组的渗漏率高于无终板骨折组(P <0.05),椎间盘损伤组的渗漏率高于无椎间盘损伤组(P <0.05);(2)单因素分析结果显示,骨水泥椎间盘渗漏与手术方式有关(P <0.05),与年龄、性别、手术椎体部位无关(P> 0.05);(3)二元logistics回归分析显示,终板骨折是强化后发生骨水泥椎间盘渗漏的独立危险因素,邻近椎间盘损伤、年龄,性别,手术方式、手术椎体部位不是骨水泥椎间盘渗漏的危险因素;(4)相关分析显示,终板骨折与椎间盘损伤存在显著相关性(r=0.47,P=0.000);(5)结果表明,术前MRI发现的终板骨折是骨水泥椎间盘渗漏的危险因素,而椎间盘损伤并非骨水泥椎间盘渗漏的影响因素,椎间盘损伤与终板骨折在骨质疏松性椎体压缩骨折患者中存在明显相关性。BACKGROUND: Studies have shown that the endplate injuries in patients with osteoporotic vertebral compression fracture are related to the intradiscal cement leakage after percutaneous vertebral augmentation.OBJECTIVE: To investigate the correlation between preoperative magnetic resonance imaging findings and intradiscal cement leakage after percutaneous vertebral augmentation, and to analyze whether endplate fractures and adjacent intervertebral disc injuries affect the incidence of intradiscal cement leakage. METHODS: Totally 182 patients with single-level osteoporotic vertebral compression fractures admitted to the Affiliated Hospital of Xuzhou Medical University from September 2018 to December 2019 were selected, of which 110 received percutaneous kyphoplasty treatment, 72 cases received percutaneous vertebroplasty treatment. According to the preoperative magnetic resonance imaging images, the condition of the adjacent intervertebral disc injury and endplate fracture of the fractured vertebral body was evaluated. According to whether there is intradiscal cement leakage after the operation, the patients were divided into a leakage group(n=32) and a non-leakage group(n=150). A univariate analysis was performed on the correlation between the patient’s age, gender, surgical spinal level, surgical method, endplate fracture, adjacent intervertebral disc injury and intradiscal cement leakage, and then a multivariate binary logistics regression model analysis was performed. The study was approved by the Medical Ethics Committee of the Affiliated Hospital of Xuzhou Medical University.RESULTS AND CONCLUSION:(1) Of the 182 patients, 63 had endplate fractures and 98 had adjacent intervertebral disc injuries. In all patients, 32 cases of intradiscal cement leakage occurred after percutaneous vertebral augmentation;the leakage rate of the endplate fracture group was higher than that of the non-endplate fracture group(P < 0.05), and the leakage rate of the intervertebral disc injury group was higher than that of the non-in

关 键 词：骨 材料 骨水泥 经皮椎体强化 骨质疏松 椎体压缩骨折 骨水泥渗漏 终板骨折 椎间盘损伤 

分 类 号：R459.9[医药卫生—治疗学] R314[医药卫生—临床医学]