经皮椎体成形术治疗老年骨质疏松性椎体压缩骨折骨水泥渗漏的危险因素分析

Risk Factors of Bone Cement Leakage Following Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures

目的探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)中骨水泥渗漏的危险因素。方法回顾性分析2020年10月至2022年6月于我院行PVP手术治疗的160例(167个椎体)OVCF病人的临床资料,其中男39例,女121例,年龄为(72.8±7.9)岁(58~93岁)。根据术后是否发生骨水泥渗漏分为渗漏组(42例,42个椎体)和无渗漏组(118例,125个椎体),采用单因素分析两组性别、年龄、身体质量指数(body mass index,BMI)、骨密度、骨折部位、伤椎皮质缺损情况、椎内裂隙征、椎基静脉孔、伤椎体积、椎体压缩率、骨水泥注入量、骨水泥注入量/伤椎体积比、骨水泥注入量/伤椎丢失体积比之间的差异,将与骨水泥渗漏有关的因素纳入Logistic回归分析,明确PVP术后骨水泥渗漏的独立危险因素。绘制ROC曲线,根据曲线下面积(area under curve,AUC)来评估模型的诊断价值。结果单因素分析结果显示,皮质缺损、椎内裂隙征、椎基静脉孔、骨水泥注入量及骨水泥注入量/伤椎丢失体积比与术后骨水泥渗漏有关(P<0.05),多因素Logistic回归分析显示椎内裂隙征[OR=5.215,95%CI(2.006,13.159),P<0.001]、椎基静脉孔[OR=3.357,95%CI(1.205,9.356),P=0.021]、骨水泥注入量[OR=2.519,95%CI(1.148,4.477),P=0.002]及骨水泥注入量/伤椎丢失体积比[OR=12.305,95%CI(1.875,80.756),P=0.009]为PVP术后骨水泥渗漏的独立危险因素。ROC曲线图显示骨水泥注入量/伤椎丢失体积比预测骨水泥渗漏的受试者工作特征AUC为0.641,且P<0.01,具有一定的预测价值。骨水泥注入量/伤椎丢失体积比预测骨水泥渗漏的Cut⁃off值为61.82%,敏感度为69.00%,特异性为38.4%。结论椎内裂隙征、椎基静脉孔、骨水泥注入量和骨水泥注入量/伤椎丢失体积比为术中骨水泥渗漏的独立危险因素,治疗时应保持骨水泥注入量/伤椎丢失体积比在61.82%以下,以降低发生骨水泥渗漏的风险。

Objectives To investigate the risk factors of bone cement leakage following percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fracture(OVCF).Methods The clinical and radiological characteristics of 160 patients(167 vertebrae)who underwent PVP in our hospital from October 2020 to June 2022 were retrospectively reviewed.There were 39 males and 121 females,aged(72.8±7.9)years old(58⁃93 years old).According to the occurrence of bone cement leakage,the patients were divided into leakage group(42 cases,42 vertebrae)and non⁃leakage group(118 cases,125 vertebrae).Univariate analysis was used to analyze the differences between the two groups in gender,age,body mass index(BMI),bone mineral density,fracture level,cortical disruption,intravertebral cleft,vertebrobasilar venous foramen,volume of the injured vertebra,compression rate of the vertebral body,bone cement volume,ratio of bone cement injection volume to volume of the injured vertebra,and ratio of bone cement volume to fractured vertebra loss volume.Factors related to bone cement leakage were included in multivariate Logistic regression analysis to identify the independent risk factors of bone cement leakage after PVP.Receiver operating characteristic(ROC)curve was drawn,and according to the area under curve(AUC)the value of prediction tests was evaluated.Results Univariate analysis showed that there were significant differences in cortical disruption,intravertebral cleft,vertebrobasilar venous foramen,bone cement volume and the ratio of bone cement volume to fractured vertebra loss volume between groups(P<0.05).Multivariate Logistic regression analysis showed that intravertebral cleft[OR=5.215,95%CI(2.006,13.159),P<0.001],vertebrobasilar venous foramen[OR=3.357,95%CI(1.205,9.356),P=0.021],bone cement volume[OR=2.519,95%CI(1.148,4.477),P=0.002]and the ratio of bone cement volume to fractured vertebra loss volume[OR=12.305,95%CI(1.875,80.756),P=0.009]were independent predictors of postoperative bone cement leakage after PVP.The ROC curve showed that the AUC of ratio of bone cement volume to fractured vertebra loss volume in the prediction of bone cement leakage was 0.641,and P<0.01,which had certain prediction value.The best cut⁃off point for the prediction of bone cement leakage with ratio of bone cement volume to fractured vertebra loss volume was 61.82%,sensitivity was 69.00%and specificity was 38.40%.Conclusion Intravertebral cleft,vertebrobasilar venous foramen,bone cement volume and the ratio of bone cement volume to fractured vertebra loss volume are independent risk factors for postoperative bone cement leakage.The ratio of bone cement volume to fractured vertebra loss volume should be kept below 61.82%to reduce the risk of bone cement leakage.