Kümmell's病椎体成形术骨水泥渗漏危险因素

Risk factors related to cement leakage in percutaneous vertebroplasty for Kümmell’s disease

[目的]分析老年Kümmell’s病椎体成形术(percutaneous vertebroplasty,PVP)后骨水泥渗漏危险因素。[方法]2018年5月—2021年5月,作者对106例(134个椎体)老年Kümmell’s病患者行PVP治疗,依据是否发生骨水泥渗漏将患者分为渗漏组和无渗漏组,采用单因素比较和二分变量多因素逻辑回归分析骨水泥渗漏的危险因素。[结果]106例(134个椎体)中,57个椎体发生骨水泥渗漏,渗漏率为42.54%(57/134)。单项因素比较表明,与无渗漏组相比,渗漏组的Kümmell’s病分期更重,骨折部位中腰椎比率更高,椎体损伤中裂隙损伤比率更高、骨水泥量更大、骨水泥形态呈弥漫状的比率更高,差异有统计学意义(P<0.05)。逻辑回归分析表明,骨水泥分布呈弥漫状(OR=4.450,95%CI:1.989~9.957,P<0.001)、骨折部位在腰椎(OR=4.380,95%CI:1.880~10.202,P=0.004)、骨水泥注射量大(OR=3.896,95%CI:1.133~13.401,P<0.001)、椎体损伤类型为裂隙状(OR=3.518,95%CI:1.239~9.995,P<0.001)是老年Kümmell’s病患者PVP后骨水泥渗漏的独立危险因素。[结论]骨水泥分布形态、骨折部位在腰椎、骨水泥注入量大、椎体损伤类型为裂隙型是老年Kümmell’s病PVP后骨水泥渗漏的相关危险因素,临床应针对性加强防范。

[Objective]To explore the risk factors related to bone cement leakage secondary to percutaneous vertebroplasty(PVP)for Kümmell’s disease in the elderly.[Methods]A retrospective study was conducted on 106 elderly patients(134 vertebrae)who underwent PVP for Kümmell’s disease in our department from May 2018 to May 2021.Based on whether or not bone cement leakage happened secondary to PVP,the patients were fall into the leakage group or non-leakage group.Univariate comparison and binary multiple logistical regression were conducted to search the factors related to the bone cement leakage in PVP.[Results]Of the 106 patients(134 vertebrae),57 vertebrae proved of bone cement leakage,accounting for 42.54%(57/134).In term of univariate comparison,the leakage group was of significantly more severe Kümmell’s staging,higher ratio of lumbar involved in the location,higher ratio of vertebral fissures found in vertebral injury typing,greater bone cement volume used,and higher ratio of diffused distribution of bone cement than the non-leakage group(P<0.05).As results of logistic regression,diffused distribution of bone cement(OR=4.450,95%CI:1.989~9.957,P<0.001),the lumbar involved in fracture site(OR=4.380,95%CI:1.880~10.202,P=0.004),greater bone cement amount injected(OR=3.896,95%CI:1.133~13.401,P<0.001)and the fissure-like lesion in vertebral body injury(OR=3.518,95%CI:1.239~9.995,P<0.001)were independent factors related to bone cement leakage secondary to PVP for Kümmell’s disease in the elderly.[Conclusion]Fracture site in lumbar,diffused distribution of bone cement,more amount of bone cement,and fissure-like lesion are the risk factors for bone cement leakage in PVP,which should be paid attention to for prevention of bone cement leakage in clinical setting.