椎体成形治疗中骨水泥渗漏的因素与临床分析

Cement leakage factors in clinical vertebroplasty

背景:椎体成形术及椎体后凸成形术是治疗老年骨质疏松性椎体压缩性骨折的重要方法。由于骨水泥自身具有一定流动性以及椎体骨折情况不同,治疗过程中骨水泥渗漏率依然较高。目的:通过理论探讨和临床分析,研究骨水泥渗漏相关原理以及有效预防方法。方法:根据术者习惯,将162例骨质疏松性椎体压缩骨折患者(186个椎体)分为3组。A组:64例78个椎体用普通推杆骨水泥成形术工具套件进行椎体成形术;B组:57例65个椎体用带骨水泥泵手柄连杆骨水泥成形术工具套件行椎体成形术;C组:41例43个椎体用带球囊扩张椎体后凸成形术工具套件行椎体后凸成形术。观察3组骨水泥渗漏情况。结果与结论:①术后出现骨水泥渗漏25个椎体,发生率为13%(25/186);②A组骨水泥渗漏11个椎体,渗漏率为14%(11/78),B组骨水泥渗漏8个椎体,渗漏率为12%(8/65),C组骨水泥渗漏6个椎体,渗漏率为14%(6/43)。3组骨水泥渗漏率统计学比较差异无显著性意义(P>0.05);③骨水泥渗漏原因具有不完全可控性,渗漏位置也有一定随机性。严密谨慎的影像学监测是预防骨水泥渗漏的直观方法。

BACKGROUND:Vertebroplasty(PVP)and kyphoplasty(PKP)are important methods for the treatment of osteoporotic vertebral compression fractures in the elderly.Although bone cement has certain liquidity and vertebral fractures are often in different situations,bone cement leakage rate is still high.OBJECTIVE:Based on the theoretical discussion and clinical analysis,to study the theoretical causes of bone cement leakage and effective prevention methods.METHODS:A total of162cases(186vertebrae)were treated with three methods of vertebroplasty.Group A:64cases with78vertebrae were treated with conventional cemented vertebroplasty;Group B:57cases with65vertebrae were treated with cemented vertebroplasty using cement pump;Group C:41cases with43vertebrae were treated with balloon kyphoplasty.The leakage of bone cement was observed in three groups.RESULTS AND CONCLUSION:Of the186vertebrae,postoperative bone cement leakage occurred in25vertebrae,with the leakage rate of13%(25/186).Group A had bone cement leakage in11vertebrae,and the leakage rate was14%(11/78).Group B had bone cement leakage in8vertebrae,and the leakage rate was12%(8/65).Group C had bone cement leakage in6vertebrae,and the leakage rate was14%(6/43).There was no significant difference among the three groups in the leakage rate of bone cement(P>0.05).That is to say,the causes of bone cement leakage are not completely controllable,and the leakage position has some randomness.Strict and careful imaging monitoring is an intuitive method to prevent bone cement leakage.