骨质疏松性椎体压缩骨折行经皮椎体成形术后骨水泥渗漏危险因素分析

Risk factors of bone cement leakage after percutaneous vertebroplasty for osteoporotic vertebral compression fracture

目的探讨骨质疏松性椎体压缩骨折(OVCF)行经皮椎体成形术(PVP)后骨水泥渗漏的危险因素。方法采用多中心大样本病例对照研究分析4所医院2018年5月至2021年10月收治的2273例(2689个椎体)OVCF行PVP患者临床资料,其中男994例,女1279例;年龄52~91岁[(69.1±3.1)岁]。根据是否出现骨水泥渗漏分为渗漏组(581例,604个椎体)和无渗漏组(1692例,2085个椎体)。记录患者性别、年龄、骨折部位、椎体压缩率、上下终板完整性、手术节段、手术入路及骨水泥注入量等指标。采用单因素分析上述指标与PVP术后骨水泥渗漏的相关性,再通过多因素Logistic回归分析明确PVP术后骨水泥渗漏的独立危险因素。结果单因素分析结果显示,性别、年龄、骨折部位、椎体压缩率、骨水泥注入量与PVP术后骨水泥渗漏相关(P<0.05或0.01);上下终板完整性、手术节段、手术入路与PVP术后骨水泥渗漏不相关(P均>0.05)。多因素Logistic回归分析结果表明,胸椎骨折(OR=1.68,95%CI 1.11~2.55,P<0.05)、椎体压缩率>40%(OR=1.98,95%CI 1.29~3.02,P<0.01)、骨水泥注入量≥5.5 ml(OR=1.55,95%CI 1.07~2.26,P<0.05)与PVP术后骨水泥渗漏显著相关。结论胸椎骨折、椎体压缩率>40%、骨水泥注入量≥5.5 ml是OVCF行PVP术后骨水泥渗漏的独立危险因素。

Objective To investigate the risk factors of bone cement leakage after percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fracture(OVCF).Methods A multi-center,large-sample,case-control study was carried out to analyze the clinical data of 2273 OVCF patients(2689 vertebrae)undergone PVP at four hospitals between May 2018 and October 2021,including 994 males and 1279 females,with the age of 52-91 years[(69.1±3.1)years].Of all,581 patients(604 vertebrae)were allocated to leakage group and 1692 patients(2085 vertebrae)to no leakage group according to the occurrence of bone cement leakage.The gender,age,fracture sites,vertebral compression degree,endplate integrity of fractured vertebrae,surgical segments,surgical approaches and bone cement injection volume were recorded.Univariate analysis was used to investigate the correlation between those indicators with bone cement leakage.Multivariate Logistic regression analysis was used to identify the independent risk factors for bone cement leakage.Results Univariate analysis showed that gender,age,fracture sites,vertebral compression degree,bone cement injection volume were related to bone cement leakage after PVP(P<0.05 or 0.01),but no correlation was found in the endplate integrity of fractured vertebrae,surgical segments and surgical approaches(all P>0.05).Multivariate Logistic regression analysis showed that fracture sites(OR=1.68,95%CI 1.11-2.55,P<0.05),vertebral compression degree more than 40%(OR=1.98,95%CI 1.29-3.02,P<0.01),bone cement injection volume greater than or equal to 5.5 ml(OR=1.55,95%CI 1.07-2.26,P<0.05)were significantly associated with bone cement leakage after PVP.Conclusion Thoracic vertebral fracture,vertebral compression degree more than 40%and bone cement injection volume greater than or equal to 5.5 ml are independent risk factors for bone cement leakage after PVP in OVCF.