单侧双侧椎弓根入路PVP术治疗上段胸椎骨质疏松性骨折患者疗效及骨水泥渗漏高危因素分析

Efficacy and High-Risk Factors of Cement Leakage in Unilateral and Bilateral Pedicle Approach PVP for Osteoporotic Fractures of the Upper Thoracic Vertebrae

目的:分析单侧、双侧椎弓根入路经皮椎体成形术(PVP)对上段胸椎骨质疏松性骨折患者的治疗效果,并探究影响骨水泥渗漏的高危因素。方法:以2021年6月至2023年6月于本院接受PVP手术的151例上段胸椎骨质疏松性骨折患者为研究对象进行回顾性分析,以80例单侧椎弓根入路患者为单侧组,以71例双侧椎弓根入路患者为双侧组。比较两组手术时间、出血量及术中骨水泥渗漏的发生率,比较两组术后7d的疼痛情况。依据其术中骨水泥渗漏发生情况分为渗漏组和未渗漏组,采用Logistic多因素分析影响骨水泥渗漏的高危因素。结果:与双侧组相比,单侧组的手术时间缩短,出血量减少,术中骨水泥渗漏率降低(P<0.05);单侧组术后7d的疼痛程度较双侧组明显减轻(P<0.05)。渗漏组与未渗漏组的年龄、骨水泥弥散类型、脊柱后凸Cobb角、终板/后壁不完整等情况比较差异有统计学意义(P<0.05);Logistic多因素分析结果显示,年龄≥70岁,骨水泥弥散类型为弥散型、高脊柱后凸Cobb角、终板/后壁不完整为PVP术中骨水泥渗漏的高危因素(P<0.05)。结论:与双侧入路PVP术相比,单侧椎弓根入路PVP术的治疗效果更显著。PVP术中骨水泥渗漏受多种因素影响,临床应在术前综合评价患者的情况,采取优化措施,以降低骨水泥渗漏的发生。

Objective:To analyze the therapeutic effect of unilateral and bilateral pedicle approach percutaneous vertebroplasty(PVP)on patients with upper thoracic osteoporotic fractures,and to explore the high-risk factors affecting bone cement leakage.Methods:A retrospective analysis was conducted on 151 patients with osteoporotic fractures of the upper thoracic vertebrae who underwent PVP surgery in our hospital from June 2021 to June 2023.Among them,80 patients with a unilateral pedicle approach were designated as the unilateral group,and 71 patients with a bilateral pedicle approach were designated as the bilateral group.The surgery time,blood loss,and intraoperative cement leakage rate were compared between the two groups,along with the pain levels 7 days post-operation.Based on the occurrence of intraoperative cement leakage,patients were divided into the leakage group and the non-leakage group.Logistic multivariate analysis was used to identify high-risk factors for cement leakage.Results:Compared with the bilateral group,the unilateral group had shorter surgery time,less blood loss,and a lower rate of intraoperative cement leakage(P<0.05).The pain level in the unilateral group 7 days post-operation was significantly lower than in the bilateral group(P<0.05).Statistically significant differences were observed between the leakage and non-leakage groups in terms of age,cement dispersion type,spinal kyphosis Cobb angle,and endplate/posterior wall integrity(P<0.05).Logistic multivariate analysis revealed that age≥70 years,dispersive type of cement dispersion,high spinal kyphosis Cobb angle,and incomplete endplate/posterior wall were high-risk factors for intraoperative cement leakage in PVP(P<0.05).Conclusion:The unilateral pedicle approach PVP surgery shows more significant therapeutic effects compared to the bilateral approach.Various factors influence cement leakage during PVP surgery,and clinical practice should include a comprehensive preoperative evaluation of patients'conditions and optimization measures to reduce the incidence of cement leakage.