骨质疏松性椎体压缩骨折行经皮椎体后凸成形术后骨水泥渗漏和伤椎再塌陷的危险因素分析  

Risk factors for bone cement leakage and recompression of injured vertebrae after percutaneous kyphoplasty for osteoporotic vertebral compression fracture

作　　者：林铖 陈唐亦衡 刘义杰[1] 李雪峰[1] 杨惠林[1] 姜为民[2] Lin Cheng;Chen-TangYiheng;Liu Yijie;Li Xuefeng;Yang Huilin;Jiang Weimin(Department of Orthopedics,First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Orthopedics,Dushuhu Public Hospital Affiliated to Soochow University,Suzhou 215127,China)

机构地区：[1]苏州大学附属第一医院骨科,苏州215006 [2]苏州大学附属独墅湖医院骨科,苏州215127

出　　处：《中华创伤杂志》2022年第6期531-537,共7页Chinese Journal of Trauma

基　　金：国家骨科与运动康复临床医学研究中心以临床应用为导向的医疗创新基金(2021-NCRC-CXJJ-PY-16)。

摘　　要：目的探讨骨质疏松性椎体压缩骨折(OVCF)行经皮椎体后凸成形术(PKP)后骨水泥渗漏和伤椎再塌陷的危险因素。方法采用病例对照研究分析2017年1月至2021年1月苏州大学附属第一医院收治的297例单节段OVCF行PKP患者的临床资料,其中男67例,女230例;年龄60~92岁[(69.5±8.2)岁]。根据是否出现骨水泥渗漏分为渗漏组(36例)和非渗漏组(261例),根据是否出现伤椎再塌陷分为再塌陷组(40例)和非再塌陷组(257例)。记录各组性别、年龄、骨折节段、骨折类型、骨折严重程度、骨皮质破坏、椎体裂隙征、术前及术后局部后凸角、后凸角纠正值、骨水泥注入量、骨水泥分布形态、术后抗骨质疏松治疗情况。采用单因素分析上述指标与PKP术后骨水泥渗漏和伤椎再塌陷的相关性。采用多因素Logistic回归分析确定PKP术后骨水泥渗漏和伤椎再塌陷的独立危险因素。结果单因素分析结果显示,骨折严重程度、骨皮质破坏、骨水泥注入量与骨水泥渗漏相关(P<0.05或0.01);性别、年龄、骨折节段、骨折类型、椎体裂隙征、术前及术后局部后凸角、后凸角纠正值、骨水泥分布形态、术后抗骨质疏松治疗与骨水泥渗漏不相关(P均>0.05)。单因素分析结果显示,椎体裂隙征、骨水泥分布形态、术后抗骨质疏松治疗与伤椎再塌陷相关(P均<0.01);性别、年龄、骨折节段、骨折类型、骨折严重程度、骨皮质破坏、术前及术后局部后凸角、后凸角纠正值、骨水泥注入量与伤椎再塌陷不相关(P均>0.05)。多因素Logistic回归分析结果表明,重度骨折(OR=4.23,95%CI 1.52~11.81,P<0.01)、骨皮质破坏(OR=3.29,95%CI 1.52~7.13,P<0.01)、骨水泥注入量>8 ml(OR=2.31,95%CI 1.09~4.92,P<0.05)与骨水泥渗漏显著相关。多因素Logistic回归分析结果表明,椎体裂隙征(OR=2.10,95%CI 1.03~4.30,P<0.05)、骨水泥团块状分布(OR=2.56,95%CI 1.25~5.27,P<0.05)、术后未抗骨质疏松治疗Objective To investigate the risk factors of bone cement leakage and recompression of injured vertebrae after percutaneous kyphoplasty(PKP)for osteoporotic vertebral compression fracture(OVCF).Methods A case-control study was performed to analyze the clinical data of 297 patients with single-segment OVCF who underwent PKP in First Affiliated Hospital of Soochow University from January 2017 to January 2021,including 67 males and 230 females;aged 60-92 years[(69.5±8.2)years].According to the occurrence of bone cement leakage,the patients were divided into leakage group(n=36)and no leakage group(n=261).According to the occurrence of recompression of injured vertebrae,the patients were divided into recollapse group(n=40)and no recollapse group(n=257).The gender,age,fracture segment,type of fracture,fracture severity,cortical disruption,intravertebral cleft,preoperative and postoperative local kyphosis angle,correction value of local kyphosis angle,bone cement injection volume,bone cement distribution,and postoperative anti-osteoporosis treatment were recorded.Univariate analysis was used to analyze the correlation of those factors with bone cement leakage and recompression of injured vertebrae after PKP,followed by multivariate Logistic regression analysis to identify the independent risk factors.Results Univariate analysis showed that fracture severity,cortical disruption and bone cement injection volume were related to bone cement leakage(P<0.05 or 0.01).Gender,age,fracture segment,type of fracture,intravertebral cleft,preoperative and postoperative local kyphosis angle,correction value of local kyphosis angle,bone cement distribution,and postoperative anti-osteoporosis treatment were not related to bone cement leakage(all P>0.05).Univariate analysis showed that intravertebral cleft,bone cement distribution,and postoperative anti-osteoporosis treatment were associated with recompression of injured vertebrae(all P<0.01).Gender,age,fracture segment,type of fracture,fracture severity,cortical disruption,preoperative

关 键 词：骨质疏松 脊柱骨折 椎体后凸成形术 手术后并发症 危险因素 

分 类 号：R687.3[医药卫生—骨科学]