椎体成形术骨水泥渗漏的相关危险因素分析

Relative risk factors of bone cement leakage after vertebroplasty and kyphoplasty

目的探寻经皮椎体成形术（PVP）与经皮后凸成形术（PKP）治疗椎体骨质疏松性压缩性骨折出现骨水泥渗漏的相关危险因素。方法回顾性分析2008年1月—2014年6月收治的PVP和PKP患者108例（114个椎体）。根据是否出现骨水泥渗漏将患者分为骨水泥渗漏组（32例）和无骨水泥渗漏组（76例），对两组患者的性别、年龄、一次性治疗椎体的个数、伤椎解剖位置、术式选择（PKP或PVP）、椎体后壁的完整性、穿刺方式（单侧或双侧）、医师的技术水平、骨水泥注入量等资料进行统计分析。结果术后共36个椎体（31．6％）出现骨水泥渗漏，78个椎体无骨水泥渗漏。性别、年龄、伤椎解剖位置、穿刺路径的选择、主刀医师的专业技术水平与骨水泥渗漏无相关性（P〉0．05）；而一次性治疗椎体的个数、术式的选择、椎体的骨折情况、骨水泥注入量与骨水泥渗漏有相关性（P〈0．05）。结论椎体成形术后骨水泥渗漏与一次性治疗椎体的个数、术式的选择、椎体的骨折情况、骨水泥注入量有关。掌握正确的操作方法和适应证、注入适量的高黏度骨水泥量，可以减少骨水泥渗漏的发生。

Objective To investigate the related risk factors of bone cement leakage after percu- taneous vertebroplasty （PVP） and percutaneous kyphoplasty （PKP） of osteoporotic vertebral compression fracture. Methods A retrospective study was made on 108 patients （114 vertebrae） undergone PVP and PKP between January 2008 and June 2014. There were 32 patients with cement leakage and 76 pa- tients without cement leakage. Between-group differences were analyzed in terms of gender, age, number of one-time treated vertebrae, anatomic dissection, surgical procedures （ PKP or PVP）, integrity of the posterior vertebral wall, puncture approaches （ unilateral or bilateral ）, technical level of surgeons and bone cement volume. Results Bone cement leakage occurred in 36 vertebrae （with the proportion of 31.6% ）. Cement leakage was associated with number of one-time treated vertebrae, surgical procedures, fractured condition, and bone cement volume （ P 〈 0. 05）, but not with gender, age, anatomical site of in- jury, puncture approaches, and technical level of surgeons （ P 〉 0. 05 ）. Conclusions Bone cement leakage after PKP or PVP correlated with number of vertebrae with one-time therapy, surgical procedures, fractured condition, and volume of bone cement. A good roaster of technical procedures and indications and suitable injection of high viscosity bone cement can help reduce the incidence of cement leakage.