影响经皮椎体后凸成形术球囊扩张饱满度的因素

Factors affecting plumpness of balloon dilation in percutaneous kyphoplasty

[目的]探讨经皮椎体后凸成形术(percutaneous kyphoplasty, PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture, OVCF)过程中影响球囊扩张饱满度的因素。[方法]回顾性分析本院2018年1月—2019年12月行PKP治疗的153例OVCF患者的临床资料。按术中球囊扩张形态分成饱满组与未饱满组,采用单项因素比较和二元多因素逻辑回归探讨影响PKP术中球囊扩张的相关因素。[结果]所有患者均顺利完成手术,均无严重并发症。术中透视确认球囊扩张饱满103例,占67.32%;球囊扩张不饱满50例,占32.68%。单因素比较,两组年龄、性别、BMI、BMD、伤椎节段分布、手术时间、骨水泥注入量、术后下地时间及完全负重时间差异均无统计学意义(P>0.05)。与饱满组相比,未饱满组的病程显著延长(P<0.05),椎体内真空现象(intravertebral vaccum phenomina, IVP)的比率显著增高(P<0.05),椎体压缩度和局部Cobb角均显著增大(P<0.05),PKP术后伤椎再骨折发生率显著升高(P<0.05)。二元多因素逻辑回归表明,椎体裂隙征比率高(OR=74.189,P<0.05)、局部Cobb角大(OR=3.438,P<0.05)、椎体压缩度高(OR=1.270,P<0.05)及病程长(OR=1.057,P<0.05)是造成PKP术中球囊扩张未饱满的独立危险因素。[结论]椎体裂隙征比率高、局部Cobb角大、椎体压缩度严重和病程长是造成PKP术中球囊扩张未饱满的因素,应引重视。此外,球囊扩张未饱满可增加术后伤椎再骨折的风险。

[Objective] To explorthe factors affecting plumpness of balloon dilation in percutaneous kyphoplasty(PKP) for osteoporotic vertebral compression fractures(OVCF). [Methods] A retrospective study was done on total of 153 patients who received PKP for OVCF in our hospital from January 2018 to December 2019. According to the intraoperative balloon dilation shape, the patients were divided into the full-dilation group(the FD) and the non-full dilation group(the NFD). Univariate comparison and binary multiple logistic regression were conducted to search the factors influencing the intraoperative balloon dilation in PKP. [Results] All patients were successfully operated on without serious complications. The intraoperative fluoroscopy confirmed that the balloon fully dilated in 103 patients, accounting for 67.32%,while not fully dilated in 50 patients, accounting for 32.68%. In term of univariate comparison, although there were no significant differences in age, gender, BMI, BMD, vertebral segment distribution, operation time, bone cement injection amount, postoperative walking time and the time to resum full-weight-bearing activity between the two groups(P>0.05), the NFD group had significantly longer course of disease(P<0.05), significantly higher incidence of intravertebral vaccum phenomina(IVP)(P<0.05), significantly higher ratio of vertebral compression and greater local Cobb angle(P<0.05), and significantly higher incidence of vertebral re-fracture after PKP(P<0.05) compared with the FD group. As results of binary multifactor logistic regression, the IVP(OR=74.189, P<0.05), the greater local Cobb angle(OR=3.438, P<0.05), higher ratio of vertebral compression(OR=1.270, P<0.05), and longer course of disease(OR=1.057, P<0.05) were the independent risk factors for inadequate balloon dilation in PKP. [Conclusion] The IVP, large local cobb angle, severe vertebral compression and long course of disease are the factors related to the incomplete balloon dilation in PKP, which should be paid attention to. In addition,inadequate balloon dilation also increases the risk of refracture of the injured vertebrae.