骨质疏松性椎体压缩骨折经皮椎体成形术后骨水泥椎管内渗漏的危险因素分析

Analysis of risk factors for intraspinal cement leakage in the treatment of osteoporotic vertebral compression fracture by percutaneous vertebroplasty

目的探讨经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折(OVCF)发生骨水泥椎管内渗漏的危险因素。方法采用回顾性病例对照研究方法,分析2018年1月—2021年12月于北京市通州区中西医结合医院行PVP治疗的156例OVCF患者的临床资料。分析患者术后CT影像学结果,根据是否发生骨水泥椎管内渗漏分为两组:渗漏组(n=28)和无渗漏组(n=128)。计量资料以均数±标准差(±s)表示,疼痛视觉模拟评分(VAS)组间比较采用t检验;计数资料以例数和百分率[例(%)]。采用单因素和多因素Logistic回归分析评价患者术后发生骨水泥椎管内渗漏的危险因素。结果所有患者均顺利完成手术,术中、术后均未出现明显的不良反应和严重的并发症。单因素Logistic回归分析结果显示,较高的骨密度(P=0.005)、OVCF合并椎体后壁损伤(P<0.001)和较高的骨水泥用量(P=0.013)是导致OVCF患者发生骨水泥椎管内渗漏的危险因素。多因素Logistic回归分析结果显示,较高的骨密度(P=0.009,95%CI:0.152~0.762,OR=0.340),OVCF合并椎体后壁损伤(P=0.001,95%CI:2.134~15.780,OR=5.803)和较高的骨水泥用量(P=0.005,95%CI:1.175~2.505,OR=1.715)是OVCF患者发生骨水泥椎管内渗漏的独立影响因素。结论骨水泥椎管内渗漏为PVP术中常见的并发症,较高的骨密度、OVCF合并椎体后壁损伤和较高的骨水泥用量是OVCF患者PVP术后发生骨水泥椎管内渗漏的独立危险因素。

ObjectiveTo investigate the risk factors of intraspinal cement leakage in the treatment of osteoporotic vertebral compression fracture by percutaneous vertebroplasty(PVP).MethodsFrom January 2018 to December 2021,156 patients with OVCF who received surgical treatment in Beijing Tongzhou Integrated Traditional Chinese and Western Medicine Hospital were enrolled in this retrospective case-control study.The postoperative CT imaging results were analyzed,and the patients were divided into two groups according to the occurrence of intraspinal cement leakage:leakage group(n=28)and non-leakage group(n=128).Measurement data was expressed as mean±standard deviation(±s),and t-test was used for comparison of visual analogue score(VAS)between groups;the count data was expressed as the number of cases and percentage(%);univariate and multivariate Logistic regression analysis were used to evaluate the risk factors of postoperative intraspinal cement leakage.ResultsAll the patients were treated by PVP successfully,without obvious adverse reactions and serious complications occurred during and after the operation.Univariate Logistic regression analysis showed that higher bone mineral density(P=0.005),OVCF combined with posterior vertebral wall injury(P<0.001)and higher bone cement dosage(P=0.013)were the risk factors leading to intraspinal cement leakage.Multivariate Logistic regression analysis showed that higher bone mineral density(P=0.009,95%CI:0.152-0.762,OR=0.340),OVCF combined with posterior vertebral wall injury(P=0.001,95%CI:2.134-15.780,OR=5.803),and higher bone cement dosage(P=0.005,95%CI:1.175-2.505,OR=1.715)were the independent risk factors of intraspinal cement leakage.ConclusionIntraspinal cement leakage was common complication after PVP.Higher bone mineral density,OVCF combined with posterior vertebral wall injury,and higher bone cement dosage were the independent risk factors affecting intraspinal cement leakage.