骨折程度对经皮椎体成形术后骨水泥渗漏率的影响分析

The Effect of Fracture Severity on Cement Leakage in Percutaneous Vertebroplasty

目的探讨骨折程度对经皮椎体成形术后骨水泥渗漏率的影响。方法回顾性分析2015年11月至2019年6月1015例骨质疏松性椎体压缩骨折经皮椎体成形术患者的临床资料。根据骨折程度分为:轻度783例,中度164例,重度68例。三组基线数据比较差异无统计学意义(P>0.05)。根据渗漏后果分为:经椎基底静脉型(B型)、经节段静脉型(S型)、经骨皮质型(C型)、椎间盘内渗漏型(D型)。根据渗漏机制分为:静脉渗漏(B型和/或S型)、皮质渗漏(C型和/或D型)。比较三组各类渗漏率、总渗漏率差异是否具有统计学意义。结果三组的渗漏类型及渗漏率分别为:B型34.7%、25.6%、11.8%,S型47.9%、34.1%、19.1%,C型12.5%、20.7%、30.9%,D型8.3%、17.1%、29.4%;静脉渗漏61.4%、45.7%、25.0%;皮质渗漏19.4%、35.4%、51.5%,差异均有统计学意义(P<0.05)。三组总渗漏率分别为74.3%、68.9%、69.1%,差异无统计学意义(P>0.05)。结论骨折程度越重,骨水泥经血管途径渗漏风险越低,经皮质途径渗漏风险越高。骨折程度对总渗漏率无显著影响。

Objective To evaluate the effect of fracture severity on cement leakage in percutaneous vertebroplasty.Methods A total of 1015 patients who underwent PVP for OVCF between November 2015 and June 2019 were retrospectively reviewed.According to the fracture severity grade,all the treated vertebrae were stratified into three groups:mild fracture(783 levels),moderate fracture(164 levels),and severe fracture(68 levels).The data on baseline of the three groups were comparable(P>0.05).According to the different potential sequelae,all cement leakage were classified into four types:through the basivertebral vein(type B),through the segmental vein(type S),through a cortical defect(type-C),and intradiscal leakage(type D).Furtherly,any cement leakage were divided into two types:the venous leakage and the cortical leakage,considering the different leakage mechanism.Results In mild,moderate,and severe fractures,the rate of type-B were 34.7%、25.6%、and 11.8%,respectively.The rate of type-S were 47.9%,34.1%,and 19.1%,respectively.The rate of type-C were 12.5%,20.7%,and 30.9%,respectively.The rate of type-D were8.3%,17.1%,and 29.4%,respectively.The rate of venous leakage were 61.4%,45.7%,and 25.0%,respectively.The rate of cortical leakage were 19.4%,35.4%,and 51.5%,respectively.There were significant differences among three groups on term of each type leakage mentioned above(P<0.05).However,there was no significant difference among three groups regarding the leakage in general(P>0.05),with the rate of 74.3%,68.9%,and 69.1%,respectively.Conclusion As fracture severity grade increased,the risk of leakage through vein decreased and the risk of leakage through cortex increased.However,there was no significant correlation between fracture severity and leakage in general.