经皮椎体后凸成形术骨水泥渗漏的相关因素研究

Factors related to leakage of bone cement after percutaneous kyphoplasty

摘要:

目的  探究经皮椎体后凸成形术（PKP）骨水泥渗漏的相关因素，以期能为后期治疗提供参考。方法  选取2010年1月-2015年1月四川省眉山市中医医院收治的256例采用PKP治疗的骨质疏松性椎体压缩骨折患者为研究对象，回顾性分析256例患者的临床资料，探究PKP手术后骨水泥渗漏的相关因素。结果  256例患者中共有100例患者发生骨水泥渗漏，骨水泥渗漏发生率为39.06％。其中3例椎管内硬膜外渗漏患者和1例脊柱旁软组织渗漏患者出现神经根受压迫症状和脊髓受压迫症状，其余患者均无显著临床症状。单因素分析结果显示，不同的术前椎体前中柱高度、术前Cobb角、一次性治疗椎体个数、椎体骨折情况、穿刺路径、主刀医师技术水平、骨水泥注入量的不同与PKP手术后骨水泥渗漏发生率之间差异有统计学意义（P <0.05）。多因素Logistic分析结果显示，术前椎体前中柱高度、术前Cobb角、穿刺路径、椎体骨折情况、骨水泥注入量为PKP手术后骨水泥渗漏的独立危险因素（P <0.05）。结论  术前椎体前中柱高度、术前Cobb角、穿刺路径、椎体骨折情况、骨水泥注入量均会对PKP手术后骨水泥渗漏产生影响，因此，掌握PKP手术适应证、使用正确的操作方法、注入适量的骨水泥能够降低骨水泥渗漏的发生率。

Abstract:

Objective To explore the factors related to leakage of bone cement after percutaneous kyphoplasty (PKP) in order to provide reference for late treatment. Methods A total of 256 patients treated with PKP for osteoporotic vertebral compression fracture in our hospital from January 2010 to January 2015 were selected  in this study. Their clinical data after surgery were retrospectively analyzed, to explore the related factors of post-PKP bone cement leakage. Results Of the 256 cases, 100 patients had leakage of bone cement, the bone cement leakage rate was 39.06%. Among the leakage patients, only 3 cases with spinal epidural leakage and 1 case with leakage of soft tissues beside vertebral column had the symptoms of nerve root compression and spinal cord compression. Univariate analysis showed that different height of preoperative anterior column, preoperative Cobb angle, number of one-time treated vertebral body, vertebral fractures, puncture path, surgeons' technical level and amount of bone cement injected were significant different from the bone cement leakage rate after PKP surgery (P < 0.05). Multivariate logistic analysis showed that the preoperative anterior vertebral column height, preoperative Cobb angle, puncture path, vertebral fractures and bone cement injection volume were the independent risk factors for bone cement leakage after PKP surgery (P < 0.05). Conclusions Preoperative anterior column height, preoperative Cobb angle, puncture path, vertebral fractures and bone cement injection volume have impact on cement leakage after PKP. Therefore, grasp of PKP indications, application of correct operation method and injection of appropriate amount of bone cement can reduce the incidence of cement leakage.