骨水泥弥散类型与椎体强化术后再发术椎塌陷的相关性分析

Analysis of the correlation between bone cement dispersion type and recurrent vertebral collapse after vertebroplasty

目的探讨骨水泥弥散类型与椎体强化术(PVP/PKP)治疗骨质疏松性压缩性骨折(OVCF)再发术椎塌陷的相关性。方法回顾性分析2009年4月～2016年5月广东省中医院收治411例采用椎体成形术治疗的患者。术后患者均接受X线检查,根据随访结果分为塌陷组与非塌陷组。单因素分析比较两组患者在性别、年龄、椎体压缩率、术椎高度恢复率、术后Cobb角纠正值、骨水泥注入量、骨水泥弥散类型、骨水泥分布区域及骨水泥渗漏方面的差异,对差异有统计学意义的因素进行Logistic回归分析。结果 411例患者均获得随访,随访时间1～37个月,平均(17.60±7.28)个月。59例手术椎体出现塌陷,发病率为14.36%。在椎体压缩率、术椎高度恢复率、骨水泥弥散类型、骨水泥渗漏方面,两组差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,骨水泥在骨折线内弥散欠佳、骨水泥呈致密型分布、术椎前缘高度恢复过度、PKP是导致椎体成形术后术椎再塌陷的危险因素(P<0.01)。结论术椎前缘高度恢复过度、骨水泥在骨折线内弥散欠佳、骨水泥呈致密型分布、PKP是椎体成形术术后出现术椎再塌陷的独立危险因素。

Objective To investigate the correlation between bone cement dispersion type and recurrent vertebral collapse after vertebroplasty（PVP/PKP） recurrent vertebral collapse after vertebroplasty. Methods Clinical data of 411 patients admitted to Guangdong Province Traditional Chinese Medical Hospital treated with vertebroplasty from April 2009 to May 2016 was analyze retrospectively. Postoperative patients all underwent X-ray examination and were divided into collapse group and non-collapse group according to the follow-up results. Univariate analysis was performed to compare the two groups in terms of gender, age, vertebral compression rate, vertebral height recovery rate, postoperative cobb angle correction value, bone cement injection volume, bone cement dispersion type, bone cement distribution area,and cement leakage. For the differences, Logistic regression analysis was performed. Results All the patients were followed up. The followed up time was from 1 to 37 months with a mean of（17.60±7.28） months. There were 59 cases occured vertebral collapse with the incidence of 14.36%. Vertebral compression rate, the vertebral height recovery rate,bone cement diffusion type, and bone cement leakage were significantly different between the two groups（P〈0.05）.The multiple Logistic regression analysis showed that, bone cement with poor dispersion in the fracture line, bone cement with a dense distribution, the vertebral anterior height recovering excessively, PKP were the risk factors for verte bral re-collapse after vertebroplasty（P〈0.01）. Conclusion The excessive recovery of the anterior vertebral height, the poor dispersion of bone cement within the fracture line, and the dense distribution of bone cement, PKP are independent risk factors for the recurrence of the vertebral surgery after vertebroplasty.