经皮椎体成形术治疗Kummell病骨水泥渗漏的术前影像学特征分析  

Preoperative imaging features of bone cement leakage in Kummell's disease treated by percutaneous vertebroplasty

作　　者：郝辉[1] 佟佳音 田倩 侯伟 杨健[1] 刘哲[1] HAO Hui;TONG Jiayin;TIAN Qian;HOU Wei;YANG Jian;LIU Zhe(Department of Radiology,the First Affiliated Hospital of Xi'an JiaotongUniversity,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院医学影像科,陕西西安710061

出　　处：《实用放射学杂志》2023年第9期1491-1494,共4页Journal of Practical Radiology

摘　　要：目的 探讨引起Kummell病经皮椎体成形术后骨水泥渗漏的术前影像学特征.方法 回顾性收集行经皮椎体成形术治疗Kummell病患者的临床、影像学资料.记录所有病例术前典型影像学征象,包含 X线(评价伤椎位置、压缩程度),CT(评价椎体终板、骨皮质、附件影像学特征及是否存在椎体裂隙),MRI(评价伤椎信号改变).根据术后骨水泥渗漏与否分为 2 组,采用χ^(2)或 Fisher精确概率法对分类变量数据进行比较;最终利用二分类 logistic 逻辑回归分析引起骨水泥渗漏的典型术前影像学征象.结果 67 例患者术后随访 1 月内发生骨水泥渗漏 38 例(占 57%).渗漏组与非渗漏组术前以下影像学征象存在统计学差异:X线椎体压缩程度(χ^(2)=6.278,P=0.043)、CT椎体裂隙征(χ^(2)=4.899,P=0.025)、椎体骨皮质不连续(χ^(2)=4.540,P=0.030).二分类lo-gistic逻辑回归结果显示术前CT椎体裂隙征为术后骨水泥渗漏的独立预测因素[比值比(OR)=3.069,P=0.029].结论 术前CT可为Kummell病治疗方案及预后提供参考,CT示椎体裂隙是Kummell病经皮椎体成形术后骨水泥渗漏的危险因子.Objective To investigate the preoperative imaging features of bone cement leakage after percutaneous vertebroplasty in Kummel's disease.Methods Clinical and imaging data of patients with Kummell's disease who underwent percutaneous verte-broplasty were retrospectively collected.All preoperative imaging features were recorded,including X-ray(to evaluate the position and the degree of compression),CT(to evaluate the imaging features of the vertebral endplate,cortical bone,appendages;and whether there are intravertebral vacuum clefts),MRI(evaluation of signal changes in injured vertebra).The patients were divided into two groups according to whether the bone cement was leaking after surgery.The data of categorical variables were compared by chi-square or Fisher exact test.Finally,binary logistic regression was used to explore the typical preoperative imaging signs causing bone cement leakage.Results A total of 67 cases were included.Bone cement leakage occurred in 38 cases(57%)within one month of postoperative follow-up.There were significant differences between the leakage group and the non-leakage group in the following pre-operative imaging signs:the degree of vertebral compression on X-ray(χ^(2)=6.278,P=0.043),the intravertebral vacuum clefts on CT(χ^(2)=4.899,P=0.025),and the vertebral cortical discontinuity(χ^(2)=4.540,P=0.030).Binary logistic regression showed that preoperative CT intravertebral vacuum clefts were an independent predictor of postoperative bone cement leakage[odds ratio(OR)=3.069,P=0.029].Conclusion Preoperative CT can provide a reference for the treatment and prognosis of Kummell's disease,CT shows that the intravertebral vacuum clefts are a risk factor for cement leakage after percutaneous vertebroplasty in Kummell's disease.

关 键 词：渗漏 计算机体层成像 椎体裂隙征 

分 类 号：R681[医药卫生—骨科学] R815[医药卫生—外科学]