骨质疏松性脊柱椎体压缩骨折经皮椎体成形后骨水泥外漏原因及治疗策略  

Cause and treatment strategy of bone cement leakage after percutaneous vertebroplasty for osteoporotic vertebral compression fractures

作　　者：陈小光[1] 刘福全[1] 张德光[1] Chen Xiaoguang;Liu Fuquan;Zhang Deguang(Department of Orthopedics,Beijing Pinggu District Hospital,Beijing 101200,China)

机构地区：[1]北京市平谷区医院骨科,北京市101200

出　　处：《中国组织工程研究》2025年第16期3311-3317,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:随着人口老龄化的加剧,骨质疏松症的发病率逐年上升,而骨质疏松性脊柱椎体压缩骨折作为其中的一种常见并发症,给患者带来了极大的痛苦和不便。经皮椎体成形术作为一种有效的治疗方法,在临床上得到了广泛应用。然而,骨水泥外漏作为该手术的一个潜在风险,一直是研究者们关注的重点。目的:探讨骨质疏松性椎体压缩骨折经皮椎体成形后骨水泥外漏的原因及处理策略。方法:选择2017年3月至2021年2月于北京市平谷区医院骨科行经皮椎体成形治疗的骨质疏松性椎体压缩骨折患者100例为研究对象,根据术后12个月随访结果分为骨水泥外漏组(n=27)和无骨水泥外漏组(n=73)。Cox比例风险回归分析筛选术后骨水泥外漏的影响因素,用以构建术后骨水泥外漏风险预测列线图模型,并对模型进行评价。行骨水泥外漏治疗后,观察术前、术后3 d、术后12个月时,27例患者的目测类比评分、Oswesry功能障碍指数。结果与结论:①27例骨水泥外漏患者中,24例均为椎间盘终板内渗漏,无明显症状及不适,无需特殊处理;1例发生肺栓塞,请呼吸科协助处理得以好转;2例有症状,行经皮椎间孔镜下骨水泥取出术;②CT值、骨折严重程度、骨水泥黏度、皮质断裂、骨水泥注入量是术后发生骨水泥外漏的独立影响因素(P<0.05);③列线图模型的校准度、区分度均较好,且具有很好的临床实用性;④对于27例术后骨水泥外漏患者,术后3 d、术后12个月时,目测类比评分均显著低于术前,差异有显著性意义(P<0.05);术后12个月的Oswesry功能障碍指数显著低于术后3 d,差异有显著性意义(P<0.05);⑤结果表明,骨水泥注入量、骨水泥黏度、皮质断裂、CT值、骨折严重程度是经皮椎体成形术后发生骨水泥外漏的危险因素。BACKGROUND:With the aging of the population,the incidence of osteoporosis is increasing year by year,and osteoporotic spinal fracture,as one of the common complications,brings great pain and inconvenience to patients.As an effective treatment,percutaneous vertebroplasty has been widely used in clinical practice.However,cement leakage as a potential risk of this procedure has been the focus of researchers.OBJECTIVE:To investigate the causes and management strategies of cement leakage after percutaneous vertebroplasty for osteoporotic vertebral compression fractures.METHODS:A total of 100 osteoporotic vertebral compression fractures patients who underwent percutaneous vertebroplasty in the Department of Orthopedics of Beijing Pinggu District Hospital from March 2017 to February 2021 were selected as the study subjects.According to the 12-month follow-up results,the patients were divided into bone cement leakage group(n=27)and non-bone cement leakage group(n=73).Cox proportional risk regression analysis was used to screen the influencing factors of bone cement leakage after surgery,so as to construct and evaluate the nomogram model for predicting the risk of bone cement leakage after surgery.Visual analog scale score and Oswesry dysfunction index of 27 patients were observed before surgery,3 days and 12 months after surgery following bone cement leakage treatment.RESULTS AND CONCLUSION:(1)Among the 27 patients with bone cement leakage,24 patients had internal leakage of intervertebral disc endplate,no obvious symptoms or discomfort,and no special treatment.Pulmonary embolism occurred in 1 case,and the patient was treated with the help of respiratory department.Two patients with symptoms underwent percutaneous intervertebral foramen endoscopic bone cement removal.(2)CT value,fracture severity,bone cement viscosity,cortical fracture,and injection amount of bone cement were the independent influencing factors for postoperative bone cement leakage(P<0.05).(3)The calibration degree and differentiation degree of the nomog

关 键 词：骨质疏松性椎体压缩骨折 骨质疏松 经皮椎体成形术 骨水泥外漏 原因分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R683.2