PVP治疗骨质疏松性椎体压缩性骨折过程中隐性失血及其危险因素分析

Analysis of hidden blood loss and its risk factors in the treatment of osteoporotic vertebral compression fractures with PVP

目的:探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗过程中出现隐性失血(hidden blood loss,HBL)的影响因素。方法:对2016年3月至2017年12月接受经皮椎体成形术治疗的125例(男55例,女70例)骨质疏松性椎体压缩性骨折的(osteoporotic vertebral compression fractures,OVCFs)临床资料进行回顾性分析。术前均行腰椎正侧位、双斜位及动力位X线片,腰椎CT、MRI及双能X射线骨密度仪(DXA)检查明确诊断。其中胸椎10例,胸腰椎89例,腰椎26例。单节段87例,双节段29例,3节段9例。67例患者椎体压缩高度比例<1/3,41例在1/3~2/3,17例>2/3。术前与术后3 d行血常规检查,分析HBL情况并探索其危险因素。结果:125例患者隐性失血为(317±156) ml。经过多重线性回归分析发现糖尿病病史(P=0.011)、手术节段(P=0.036)、节段数量(P<0.001)、椎体高度丢失率(P=0.002)、椎体高度恢复率(P<0.001)和骨水泥渗漏率(P=0.003)与隐性失血呈正相关。同时,发现椎体高度丢失率高者失血量较椎体高度丢失率低者多,椎体高度恢复良好者失血量较椎体高度恢复不良者多,水泥泄漏也是增加隐性失血的重要因素。然而,骨密度(P=0.814),高血压病史(P=0.055)与隐性失血无显著相关性。结论:OVCFs患者经过PVP治疗后隐性失血量较大,需要引起关注;同时糖尿病病史、手术节段、节段数量、骨水泥渗漏率、椎体高度丢失率和椎体高度恢复率是增加隐性失血量的危险因素。

Objective:To investigate the influencing factors of hidden blood loss(HBL) during the treatment of percutaneous vertebroplasty(PVP).Methods:The clinical data of 125 patients with osteoporotic vertebral compression fractures(OVCFs) treated with percutaneous vertebroplasty from March 2016 to December 2017 were retrospectively analyzed.All patients underwent X-rays of the AP and lateral lumbar spine,double oblique,and dynamic positions.Lumbar spine CT,MRI,and dual-energy X-ray bone densitometer(DXA) were used to confirm the diagnosis.There were 55 males and 70 females,10 cases of thoracic vertebrae,89 cases of thoracolumbar vertebrae,26 cases of lumbar vertebrae,87 cases with single segment,29 cases with double segment,and 9 cases with 3 segments.The vertebral compression height ratios of 67 patients were less than 1/3,and the ratios for 41 patients were from 1/3 to 2/3,for 17 patients were more than 2/3.Blood routine examination were performed before and 3 days after surgery to analyze hidden blood loss and to explore its risk factors.Results:The average hidden blood loss was(317±156) ml in 125 patients.Multiple linear regression analysis revealed a history of diabetes(P=0.011),surgical segments(P=0.036),number of segments(P<0.001),vertebral height loss rate(P=0.002),vertebral height recovery rate(P<0.001) and bone cement leakage rate(P=0.003) were positively correlated with hidden blood loss.Moreover,it was found that the blood loss was higher in those with higher vertebral height loss rate than in those with lower vertebral height loss rate,and the blood loss was higher in those with good vertebral height recovery than those with poor vertebral height recovery.Additionally,the cement leakage was also an important factor in increasing hidden blood loss.However,there was no significant correlation between bone mineral density(P=0.814) or history of hypertension(P=0.055) and hidden blood loss.Conclusion:Patients with OVCFs have a large amount of hidden blood loss after PVP treatment,which needs attention.At the same time,the history of diabetes,surgical segments,number of segments,bone cement leakage rate,vertebral height loss rate and vertebral height recovery rate are the risk factors for hidden blood loss.