摘要
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 body compression fracture,OVCF)中骨水泥渗漏的相关因素。方法2005年2月-2008年10月,采用PKP治疗OVCF71例171个椎体。其中男16例,女55例;年龄52～91岁,平均71.5岁。病程1～11个月,平均5.7个月。其中单个椎体19例,2个椎体21例,3个椎体20例,3个以上椎体11例。术前经影像学检查确诊为OVCF。根据骨折椎体内MRI信号变化分型,新鲜型86个椎体,亚新鲜型85个椎体。患者均无脊髓和神经根受损症状及体征。术中单个椎体骨水泥注入量1.5～6.5mL,平均4.6mL。通过观察患者手术前后椎体前中柱平均高度、Cobb角、视觉疼痛模拟评分(visual analogue scale,VAS)及Oswesty功能评分变化评估手术疗效。根据患者术后是否发生骨水泥渗漏分为渗漏组和非渗漏组,并分析发生骨水泥渗漏的相关因素。结果患者均完全耐受手术,术中未发生神经、脊髓损伤以及球囊破裂。71例均获随访,随访时间7～18个月,平均14个月。有4例(5.63%)术后3d内发生肺部并发症,均给予对症治疗,3例症状缓解,1例治愈;6例(8.45%)9个椎体术后出现继发椎体压缩骨折,无明显不适,未予处理。术后3d及末次随访时患者VAS评分、Oswesty功能评分、Cobb角及前中柱椎体平均高度均较术前明显改善(P<0.05),术后3d和末次随访时比较差异无统计学意义(P>0.05)。术后17个椎体(9.94%)发生骨水泥渗漏(渗漏组),其中7个椎体向椎旁漏出,6个椎体在椎间隙漏出,3个椎体沿椎弓根进针途径外渗,1个椎体在椎管内少量渗漏;余154个椎体为非渗漏组。单因素分析显示两组患者在术前椎体前中柱平均高度、骨水泥注入量及有无椎体周壁破坏方面比较差异有统计学意义(P<0.05),在术前Cobb角、骨折新鲜度、椎体操作部位及手术入路方面比较差异无统计学意义(P>0.05)。多因素分析显示骨水泥注入量[比值比(odds ratio,OR)=3.105,95%可信区间(confi dence interval,CI)=1.674～5.759,P<0.01)]及有无椎体周壁破坏(OR=11.960,95%CI=3.512～40.729,P<0.01)是导致PKP手术发生骨水泥渗漏的主要因素。结论骨水泥注入量及椎体周壁有无破坏是影响PKP手术发生骨水泥渗漏的主要危险因素,手术技术的提高是预防并发症的关键因素。
Objective To explore the correlative factors affecting the complications resulting from cement leakage after percutaneous kyphoplasty（PKP）in the treatment of osteoporotic vertebral body compression fractures （OVCF）.Methods From February 2005 to October 2008,71 patients with OVCF were treated by PKP and were retrospectively analyzed.There were 16 males and 55 females,and the average age was 71.5 years（range,52-91 years）.The average duration of disease was 5.7 months（range,1-11 months）.A total of 171 vertebra were involved in fracture including 19 cases of single vertebral fractures,21 cases of double vertebral fractures,20 cases of three vertebral fractures,and 11 cases of more than three vertebral fractures.All the treated vertebra were divided into acute（86 vertebra）or subacute（85 vertebra） state based on changes in MRI signal intensity.There was no radiculopathy or myelopathy.The average injected cement volume was 4.6 mL（range,1.5-6.5 mL）.The treatment efficacy was assessed by observing the change in anterior and middle vertebral column height,Cobb angle,visual analogue scale（VAS）and Oswestry functional score at preoperation,3 days after operation and last follow-up.The patients were divided into cement leakage group and no cement leakage group.All the complications were recorded,and then the correlative factors affecting the complications were analyzed.Results All the cases had rapid and significant improvement in back pain following PKP.All patients were followed up for 14 months（range,7-18 months）.There was no cement extravasation resulting in radiculopathy or myelopathy.Four patients（5.63%）had lung-related complications. During the follow-up,9 recurrence vertebral fractures were observed in 6 patients（8.45%）.The anterior and middle vertebral column height,Cobb angle,VAS and Oswestry score were significantly improved when compared with preoperation（P 0.05）.Cement leakage occurred in 17（9.94%）vertebral bodies;of 17 cases,the cement leaked into the paravertebral space in 7 cases,intervertebral space in 6 cases,channel of needling insertion in 3 cases,and spinal canal in 1 case.Univariate analysis showed statistically significant differences（P〈0.05）in preoperative anterior and middle vertebral column height,injected cement volume and vertebral body wall incompetence between the cement leakage group and no cement leakage group.There were no significant differences（P〉0.05）in preoperative Cobb angle,freshness of vertebral fracture,location of operative vertebrae and operative approach between the two groups.Multiple logistic regression analysis showed that the injected cement volume[odds ratio（OR）=3.105,95%confidence interval（CI）=1.674-5.759,P〈0.01]and vertebral body wall incompetence （OR=11.960,95%CI=3.512-40.729,P〈0.01）were the predominant variable associated with the complications resulted from cement leakage.Conclusion The injected cement volume and vertebral body wall incompetence were the factors affecting the complications.The improvement of surgical technique is the capital factor that may reduce the complications in the PKP.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第1期27-31,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
经皮椎体后凸成形术
骨质疏松性椎体压缩骨折
骨水泥渗漏
相关因素分析
Percutaneous kyphoplasty Osteoporotic vertebral body compression fracture Cement leakage Correlative factor analysis
