应用MRI预判经皮椎体增强术中骨水泥的邻近椎间盘渗漏

Prediction of cement leakage into adjacent intervertebral disc during percutaneous vertebral augmentation with preoperative magnetic resonance imaging

目的：探讨经皮椎体增强术（PVA）中应用MRI预判骨水泥的邻近椎间盘渗漏。方法：回顾性研究2006年12月至2009年10月153例骨质疏松压缩性骨折患者PVA术前MRI和术后X线资料。PVA方式为普通骨水泥椎体成形术（KMC—PVP），高黏度骨水泥椎体成形术（Confidence—PVP）和球囊扩张后凸成形术（PKP）。结果：术前MRI出现皮质带缺损共18块（缺损率4．2％），其中11块发生稚间盘渗漏（漏出率61．1％）；出现邻近椎间盘内T2W异常高信号共23节（发生率5．4％），其中10节出现椎间盘渗漏（漏出率为43．5％）。漏出率均比无上述征象时高，具统计学意义（分别为X2=180．029，P=0．000和x2=110．281，P=0．000）。91例PKP中4例出现骨水泥漏入邻近椎间盎，漏出率最低（4．4％）；19例KMC—PVP中4例发生骨水泥渗漏，漏出率最高（21．1％）；43例高粘度骨水泥一PVP中5例发生骨水泥渗漏，漏出率居中（11．6％）。不同PVA骨水泥椎间盘漏出率的差异有显著性（x2=6．364，P=0．042）。结论：术前MRI出现皮质带缺损和（或）邻近椎间盘内T2W异常高信号时容易在PVA中发生稚间盘内渗漏，此时最好选择PKP术。

Objective To investigate the use of the preoperative magnetic resonance imaging （MRI） for predicting the cement leakage into the adjacent intervertebral disc during percutaneous vertebral augmentations （PVA）. Methods A retrospective study was performed to investigate the preoperative MRI and postoperative roentgenography for 153 patients with osteoporotic vertebral compression fractures who were operated with PVA from December, 2006 to October, 2009. Three kinds of PVA were used： the percutaneous vertebroplasty using common bone cements （KMC-PVP）, the percutaneous vertebroplasty using high-viscosity bone cements （confidence-PVP）, and percutaneous kyphoplasty （PKP）. Results There were 18 cortical defects in the endplates in preoperative MRI （the defect incidence was 4.2%） and 11 of them had cement leakage into the adjacent intervertebral disc （the leakage incidence was 61.1%） ; there were 23 abnormal T2W hyperintensity in the adjacent intervertebral disc in preoperative MRI （the incidence was 5.4%）, and 10 of them had cement leakage into the disc （the leakage incidence was 43.5%）. The cortical defects and abnormal T2W hyperintensity were association with cement leakage significantly （X2 = 180.029, P = 0.000 and X2 = 110.281,P = 0.000,respectively）. Four of 91 PKPs happened leakage with the lowest leakage incidence （4.4%）, and four of 19 KMC-PVPs had leakage with the highest incidence （21.1%）. Five of 43 confidence-PVPs had leakage with the incidence of 11.6%. The difference of different PVAs was statistical significant （X2 = 6.364, P = 0.042）. Conclusions Cement leakage into adjacent intervertebral disc is more common when there is cortical defect in the endplate and T2W hyperintensity signal in the adjacent disc, then it is the best way to choose PKP for PVA.