影响PKP手术效果及并发症的要素分析  

Factors associated with surgical effect and complications in PKP

作　　者：周天诚 任延军 肖星 李经坤 张凯宁 王之锦 邹德波 Zhou Tiancheng;Ren Yanjun;Xiao Xing;Li Jingkun;Zhang Kaining;Wang Zhijin;Zou Debo(Weifang Medical University,Weifang 261053,China;Department of Orthopeadic Surgery,The First Affiliated Hospital of Shandong First Medical University,Jinan 250014,China;Shandong First Medical University,Jinan 250000,China)

机构地区：[1]潍坊医学院,山东潍坊261053 [2]山东第一医科大学第一附属医院骨外科,山东济南250014 [3]山东第一医科大学,山东济南250000

出　　处：《实用骨科杂志》2022年第5期394-400,共7页Journal of Practical Orthopaedics

摘　　要：目的探讨影响经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗椎体压缩性骨折疗效及骨水泥渗漏情况的相关因素,得出优化手术方案。方法回顾性分析山东第一医科大学第一附属医院2019—2020年因脊柱骨折行PKP治疗的56例患者,涉及68个骨折椎体,其中男性10例,女性46例;年龄51~87岁,平均年龄(69.60±8.85)岁;单节段椎体骨折48例,双节段4例,三节段4例。骨折累及节段:T_(8)2个,T_(9)2个,T_(10)4个,T_(11)14个,T_(12)5个,L_(11)4个,L_(2)6个,L_(3)9个,L_(4)8个,L_(5)4个。所有患者入院后均完善X线、CT、MRI及双能X摄线骨密度检查。完成检查后行PKP术,术后复查影像学资料,评估治疗效果,统计骨水泥渗漏病例,采用配对t检验分析手术效果,运用logistic回归分析及线性回归分析,探讨其发生原因,定制优化手术方案。结果所有患者均顺利完成手术。术后患者压缩椎体高度及伤椎Cobb角较术前均有恢复,共有36个椎体出现不同程度的无症状骨水泥渗漏。PKP的效果与骨水泥注射量、椎间盘退变、年龄、椎体压缩程度,球囊撑开体积有关(德宾-沃森≈2,VIF<5,P<0.05)。发生骨水泥椎间盘渗漏的危险因素包括较多的骨水泥注入、上终板破裂及椎体内水泥靠近上终板(霍斯默-莱梅肖检验显著性=0.780,P<0.05)。结论PKP需要完善术前影像学检查,根据椎间盘退变程度、年龄、椎体压缩程度制定手术方案,通过术中控制骨水泥注射量、球囊撑开高度及骨水泥分布方式,以取得较好的手术效果,并减少并发症的发生。Objective To explore the efficacy of percutaneous kyphoplasty(PKP)for the treatment of osteoporotic vertebral compression fractures(OVCF)and the related factors of bone cement leakage situation,and to optimize the surgical protocol.Methods We retrospectively reviewed 56 patients treated with PKP due to spinal fracture from 2019 to 2020,and the patients included 10 males and 46 females.The age ranged from 51 to 87 years,with an average of(69.60±8.85)years.The distribution of fractured vertebrae was as follows:4 cases of 3 vertebrae,4 cases of 2 vertebrae,and 48 cases of single vertebra.2 T_(8),2 T_(9),4 T_(10),14 T_(11),5 T_(12),14 L_(1),6 L_(2),9 L_(3),8 L_(4),and 4 L_(5)vertebrae.X-ray,CT,MRI,and BMD were performed on all patients before the operation.Postoperative review of imaging data,assessment of treatment effect,statistics on bone cement leakage cases.The effect of the surgery was analyzed by paired t-test,logistic regression analysis,and linear regression analysis to explore the cause and optimize the surgical protocol.Results All the operations were performed successfully.The compressed vertebral height and Cobb angle of the injured vertebrae were recovered in patients after surgery compared with those before surgery.There were 36 vertebrae with cement leakage.We found that the surgical effect of PKP was related to the amount of cement injected,the degree of disc degeneration,age,the degree of vertebral compression,and the volume of the balloon(D-W≈2,VIF<5,P<0.05).Risk factors for cement disc leakage included more cement injection,superior endplate fracture,and cement in the vertebral close to the Superior endplate(Hosmer Lemeshow test=0.780,P<0.05).Conclusion PKP needs to refine preoperative imaging studies to develop a surgical protocol based on the degree of disc degeneration,age,and degree of vertebral compression.The amount of cement injection,the volume of the balloon,and the distribution pattern of cement can be controlled intraoperatively to obtain a better surgical result and to reduce surgic

关 键 词：骨质疏松 椎体压缩性骨折 后凸成形术 骨水泥 并发症 

分 类 号：R683.2[医药卫生—骨科学]