骨质疏松性椎体压缩骨折损伤程度对经皮椎体后凸成形术后骨水泥皮质渗漏影响的研究

Effect of injury degree of osteoporotic vertebral compression fracture on bone cement cortical leakage after 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)时,椎体骨折损伤程度与术后骨水泥皮质渗漏发生的相关性,为减少手术并发症提供指导。方法以2019年11月—2021年12月接受PKP治疗且符合选择标准的125例OVCF患者作为研究对象。男20例,女105例;年龄55~96岁,中位年龄72岁。单节段骨折108例,两节段16例,三节段1例。病程1~20 d,平均7.2 d。术中骨水泥注入量2.5~8.0 mL,平均6.04 mL。基于术前CT图像测算伤椎标准S/H比值(S:伤椎标准椎体横截面最大矩形面积、H:伤椎标准椎体正中矢状位最低高度);基于术后X线片及CT图像,记录术后骨水泥渗漏发生情况,以及皮质渗漏部位术前皮质破裂情况;统计分析伤椎标准S/H比值与皮质渗漏数的相关性。结果术后伤椎发生血管渗漏67例(123处),皮质渗漏97例(299处)。对应术前CT图像分析,287处发生皮质渗漏部位在术前存在皮质破裂,皮质破裂率95.99%(287/299)。13例患者因邻椎存在椎体压缩,排除分析。最终112例伤椎标准S/H比值(1.12~3.17,平均1.67)纳入分析,其中发生皮质渗漏87例(268处)。相关分析示伤椎皮质渗漏数与伤椎标准S/H比值成正相关(r=0.493,P<0.001)。结论OVCF患者PKP术后骨水泥皮质渗漏发生率高,皮质破裂是其发生基础;椎体损伤越严重,皮质渗漏概率越大。

Objective To analyze the correlation between bone cement cortical leakage and injury degree of osteoporotic vertebral compression fracture(OVCF)after percutaneous kyphoplasty(PKP),and to provide guidance for reducing clinical complications.MethodsA clinical data of 125 patients with OVCF who received PKP between November 2019 and December 2021 and met the selection criteria was selected and analyzed.There were 20 males and 105 females.The median age was 72 years(range,55-96 years).There were 108 single-segment fractures,16 two-segment fractures,and 1 three-segment fracture.The disease duration ranged from 1 to 20 days(mean,7.2 days).The amount of bone cement injected during operation was 2.5-8.0 mL,with an average of 6.04 mL.Based on the preoperative CT images,the standard S/H ratio of the injured vertebra was measured(S:the standard maximum rectangular area of the crosssection of the injured vertebral body,H:the standard minimum height of the sagittal position of the injured vertebral body).Based on postoperative X-ray films and CT images,the occurrence of bone cement leakage after operation and the cortical rupture at the cortical leakage site before operation were recorded.The correlation between the standard S/H ratio of the injured vertebra and the number of cortical leakage was analyzed.ResultsVascular leakage occurred in 67 patients at 123 sites of injured vertebrae,and cortical leakage in 97 patients at 299 sites.Preoperative CT image analysis showed that there were 287 sites(95.99%,287/299)of cortical leakage had cortical rupture before operation.Thirteen patients were excluded because of vertebral compression of adjacent vertebrae.The standard S/H ratio of 112 injured vertebrae was 1.12-3.17(mean,1.67),of which 87 cases(268 sites)had cortical leakage.The Spearman correlation analysis showed a positive correlation between the number of cortical leakage of injured vertebra and the standard S/H ratio of injured vertebra(r=0.493,P<0.001).Conclusion The incidence of cortical leakage of bone cement after PKP in OVCF patients is high,and cortical rupture is the basis of cortical leakage.The more severe the vertebral injury,the greater the probability of cortical leakage.