经皮椎体后凸成形术骨水泥椎管内渗漏发生率及相关危险因素分析

Incidence and risk factors of intraspinal bone cement leakage in percutaneous kyphoplasty

[目的]探讨经皮椎体后凸成形术(PKP)骨水泥椎管内渗漏的发生率并行相关危险因素分析。[方法]回顾性分析2008年1月～2017年6月在本科行PKP手术治疗的474例(714个椎体)患者临床资料。观察术后手术部位X线片及CT影像分辨是否有骨水泥椎管内渗漏,依据渗漏途径和椎管内骨水泥分布情况将骨水泥椎管内渗漏分为B型、C型、P型,并分析骨水泥椎管内渗漏相关危险因素。[结果]术后52个椎体(7.28%)发生骨水泥椎管内渗漏(椎管内渗漏组),其中B型29个(55.77%),C型15个(28.85%),P型8个(15.38%)。发生有症状骨水泥椎管内渗漏7例,其中截瘫1例,AISA分级A级,急诊手术减压后,神经功能无改善;不全瘫1例,AISA分级B级,术后恢复为C级;一过性神经功能损害5例,保守治疗后均恢复正常。余662个椎体为非椎管内渗漏组。单因素分析显示两组患者骨折类型、骨水泥注入量及手术操作部位比较差异有统计学意义(P<0.05)。多因素分析显示骨水泥注入量(OR=3.306,95%CI=1.351～8.091,P<0.05)、骨折类型(OR=4.910,95%CI=1.551～15.544,P<0.05)及手术操作部位(OR=0.453,95%CI=0.219～0.939,P<0.05)是导致PKP术后发生骨水泥椎管内渗漏的主要因素。[结论] PKP术后骨水泥椎管内渗漏率约为7.28%,有症状渗漏率约为0.98%。骨水泥注入量、骨折类型及手术操作部位是导致PKP术后发生骨水泥椎管内渗漏的独立危险因素。

[Objective] To explore the incidence and risk factors of intraspinal bone cement leakage in percutaneous kyphoplasty(PKP). [Methods] A retrospective study was performed on 474 patients(714 vertebrae) who underwent PKP from January 2008 to June 2017. Postoperative X ray and CT images were taken to determine whether or not intraspinal bone cement leakages happened, which were classified into type B, C and P based on the leakage path and intraspinal canal distribution. The related risk factors of intraspinal leakage were also searched. [Results] Of the 714 vertebrae, 52 vertebrae(7.28%) were confirmed intraspinal bone cement leakages, including type B in 29 vertebrae(55.77%), type C in 15 vertebrae(28.85%) and type P in 8 vertebrae(15.38%). Seven patients presented symptomatic intraspinal bone cement leakages, including 1 patient who got complete paralysis with AISA grade A that no any functional recovery achieved after decompression surgery in emergency, 1 patient who got incomplete paralysis that improved from AISA grade B to C after corresponding treatment, and 5 patients who had temporary neurological impairment that completely recovered by conservative therapy. The remaining 662 vertebrae were proved no intraspinal bone cement leakages. Compared the patients with and without intraspinal leakages, there were statistically significant differences regarding to volume of bone cement injected, fracture types, location surgically involved(P<0.05). The multiple logical regress revealed that the volume of bone cement injected(OR=3.306, 95% CI=1.351~8.091, P<0.05), fracture types(OR=4.910, 95%CI=1.551~15.544, P<0.05), and surgical site(OR=0.453, 95%CI=0.219~0.939, P<0.05) were the fac-tors related to intraspinal bone cement leakage. [Conclusion] The incidence of intraspinal bone cement leakages in PKP is 7.28%, associated with 0.98% symptomatic leakage among the 714 vertebrae. The volume of bone cement inject-ed, fracture types, location surgically involved are the main factors related to the leakages.