经皮椎体成形术骨水泥渗漏的术前危险因素分析

Analysis of Preoperative Risk Factors for Bone Cement Leakage of Percutaneous Vertebroplasty

目的分析骨质疏松性压缩骨折(OVCFS)椎体行经皮椎体成形术(PVP)时骨水泥渗漏的术前危险因素。方法搜集2012年1月至2016年12月于本院接受PVP治疗的OVCFS患者共319例486节椎体,根据骨水泥渗漏情况分为渗漏组和无渗漏组(对照组),分别对患者一般资料包括性别和年龄及椎体影像特征包括有无裂隙征、许莫氏结节、伤椎数量(包括已行PVP术者)、伤椎的解剖位置、椎体的骨折程度、骨折形态及累及椎体皮质骨折线等数据行单因素分析,而后将上述渗漏率有显著统计学差异的数据进一步行二元Logistic回归分析。最后将搜集来的病例分为B、C、D、S型渗漏和无渗漏共五组,并对上述资料进一步行多元Logistic回归分析。结果单因素分析示性别和有无许莫氏结节的渗漏率无明显统计学差异,其他因素均有统计学差异。二元Logistic回归分析结果:终板损伤、累及椎体皮质骨折线、伤椎数量及骨折类型P值分别为0.001、0.014、0.003、0.017。多元Logistic回归分析:C型渗漏独立危险因素是累及椎体皮质骨折线(P=0.001);D型渗漏独立危险因素为终板损伤(P<0.001);伤椎数量是四种类型渗漏独立危险因素。结论当椎体存在终板损伤、累及椎体皮质骨折线、塌陷骨折或伤椎数量较多时,术者应采取合理措施防止渗漏发生。

Objective Analysis of preoperative risk factors of bone cement leakage of osteoporotic vertebral compression fractures(OVCFS) treated by percutaneous vertebroplasty(PVP).Methods A total of 319 patients(486 vertebral bodies) with osteoporosis compression fractures(OVCFS) treated by PVP from 2012 to 2016 in our hospital were assigned into two groups:control group and observation group based on whether there occurred cement leakage.Possible related factors including gender,age,intravertebral cleft,Schmorl's nodes,the number of vertebral fractures(including the treated vertebrae),anatomical location of vertebral injury,fracture severity,vertebral fracture morphology,linear body fracture extending to the Vertebral cortex and end-plate destruction were screened by single variate analysis,and then the factors which had statistical significance were investigated by Binary Logistic regression analysis.Finally the patients were assigned into five groups:control group and group B、C、D and S.The above data was further analyzed using multivariate Logistic regression analysis.Results Single variate analysis revealed that only gender and Schmorl's nodes has no significant statistical differences,while other factors were statistically different.Binary Logistic regression analysis showed that the end-plate destruction;linear body fracture extending to the Vertebral cortex;number of vertebral fracturesand vertebral fracture morphology had a statistical significance(P=0.001、0.014、0.003、0.017,respectively),Multivariate Logistic regression analysis showed that linear body fracture extending to the Vertebral cortex is the independent risk factor for type C(P=0.001).The endplate injury is the independent risk factor for type D(P < 0.001).,the number of vertebral fractures is the independent risk factor of four types.Conclusion When the vertebral body has endplate damage,involving the vertebral cortical fracture line,collapsed fracture or the number of injured vertebrae,the surgeon should take reasonable measures to prevent leakage.