基于DR、CT及MRI多征象探讨经皮胸腰椎体成形术后骨水泥渗漏危险因素  

To Explore the Risk Factors of Bone Cement Leakage after Percutaneous Thoracolumbar Body Arthroplasty Based on Multiple Signs of DR,CT and MRI

作　　者：张桂川 尤连波 葛海 邓莉 耿世遥 朱国鳌 王军大 包子华 ZHANG Gui-chuan;YOU Lian-Bo;GE Hai;DENG Li;GENG Shi-yao;ZHU Guo-ao;WANG Junda;BAO Zi-hua(Department of Radiology,Chongqing Nanchuan Hospital of traditional Chinese medicine,Chongqing 408400,China;Department of Radiology,Chongqing Hospital of Traditional Chinese Medicine,Chongqing 400021,China)

机构地区：[1]重庆市南川区中医院放射科,重庆408400 [2]重庆市中医院放射科,重庆400021

出　　处：《中国CT和MRI杂志》2023年第2期151-154,共4页Chinese Journal of CT and MRI

基　　金：重庆市2020年自然科学基金面上项目基础研究与前沿探索专项(cstc2020jcyj-msxm X0187);重庆市2019年自然科学基金面上项目基础研究与前沿探索专项(cstc2019jcyj-msxm X0555);重庆市2020年科卫联合中医药科技项目(2020ZY3539);重庆市2018年科卫联合中医药科技项目(ZY201802025);2019年“杏林学者”学科人才科研提升计划(YYZX2019064);2020年“杏林学者”学科人才科研提升计划(YYZX2020042);成都中医药大学校级基地教改建设项目(XJG2019-11950);北京中医药大学教育科学研究课题项目(XJYB2087);重庆市中医院首批青年拔尖人才专项(CQSZYY2020017);重庆市中医院第二批青年拔尖人才专项(CQSZYY2021002)。

摘　　要：目的 基于DR及CT多征象探讨经皮胸腰椎体成形术(percutaneousvertebroplasty,PVP)后骨水泥渗漏危险因素。方法 回顾性研究2020年5月-2021年4月我院87例(103个椎体)胸腰椎PVP术后骨水泥渗漏患者临床及影像学DR、CT及MRI资料,分析患者性别、年龄、椎体壁受累情况(前壁、侧壁、前壁+侧壁、前壁+侧壁+后壁不完整)、骨折类型(楔型、双凹型、塌陷型)、骨折程度(轻度、中度及重度)、病椎位置(胸椎、腰椎)、骨质密度、终板损伤、许莫氏结节、术中骨水泥用量(≤4m L或>4m L)对于骨水泥渗漏情况的影响。结果 骨折椎体壁受累、骨折程度、穿刺路径、终板损伤、骨水泥用量差异均有统计学意义(P<0.05),上述因素均为骨水泥渗漏的独立危险因素。有终板损伤的椎体骨水泥发生率最高,差异有统计学意义(P<0.05),单一途径渗漏骨折椎体壁受累、骨折程度、楔形骨折、无骨质疏松、穿刺路径、腰椎节段、终板损伤、骨水泥用量以椎间盘渗漏为主,差异有统计学意义(P<0.05);胸椎椎体伴发骨质疏松双凹及塌陷骨折致终板损伤者以椎旁软组织渗漏率最高,差异有统计学意义(P<0.05)。单一途径骨水泥渗漏者,渗漏率为椎间盘渗漏>椎旁软组织渗漏>椎旁静脉渗漏>椎管渗漏>穿刺通道渗漏,组间比较差异有统计学意义(P<0.05)。结论 骨折椎体壁受累、骨折程度、穿刺路径、终板损伤、骨水泥用量是PVP术后骨水泥渗漏的主要危险因素,术前仔细结合多种影像检查分析后采取合理的手术入路途径,减少骨水泥渗漏。Objective To explore the risk factors of bone cement leakage after percutaneous thoracolumbar vertebroplasty(PVP) based on multiple signs of DR and CT. Methods The clinical and imaging Dr,CT and MRI data of 87 patients(103 vertebral bodies) with bone cement leakage after thoracolumbar PVP in our hospital from May 2020 to April 2021 were studied retrospectively. The gender,age,vertebral wall involvement(anterior wall,lateral wall,anterior wall + lateral wall,anterior wall + lateral wall +posterior wall incomplete),fracture type(wedge-shaped,double concave,collapsed) and fracture degree(mild Moderate and severe),location of diseased vertebrae(thoracic vertebrae and lumbar vertebrae),bone mineral density,end plate injury,Schmidt’s tubercle,intraoperative bone cement dosage(≤ 4ml or > 4ml) on bone cement leakage. Results There were significant differences in vertebral wall involvement,fracture degree,puncture path,endplate injury and bone cement dosage(P<0.05). The above factors were independent risk factors of bone cement leakage. The incidence of vertebral bone cement with endplate injury was the highest,and the difference was statistically significant;The leakage rate of paravertebral soft tissue was the highest in patients with end plate injury caused by osteoporotic double concave and collapse fracture of thoracic vertebral body(P<0.05). The leakage rate of single way bone cement leakage was intervertebral disc leakage > paravertebral soft tissue leakage > paravertebral vein leakage > spinal canal leakage > puncture channel leakage. The difference between the groups was statistically significant(P<0.05). Conclusion The main risk factors of bone cement leakage after PVP are the involvement of fracture vertebral body wall,fracture degree,puncture path,endplate injury and bone cement dosage. Carefully combined with a variety of image examination and analysis before operation,a reasonable surgical approach is taken to reduce bone cement leakage.

关 键 词：经皮椎体成形术 骨水泥渗漏 骨质疏松 危险因素 终板损伤 

分 类 号：R322.71[医药卫生—人体解剖和组织胚胎学]