Tie Bin, He Shi-cheng, Teng Gao-jun, Fang Wen, Guo Jin-he, Deng Gang, Zhu Guang-yu
Department of Radiology, Affiliated Zhongda Hospital, Southeast University, Nanjing 210009, China.
Zhonghua Yi Xue Za Zhi. 2012 Feb 7;92(5):299-302.
To evaluate the influencing factors of cement leakage in vertebroplasty for the treatment of osteoporosis vertebral compression fracture (OVCF) and vertebral metastases (VM).
Retrospective analysis was conducted for 653 vertebrae in 356 patients undergoing vertebroplasty at our hospital from May 2007 to January 2011. 251 cases had 438 vertebrae with painful OVCF while 105 cases had 215 vertebrae with VM. Pre-operative computed tomography (CT) was performed to determine the presence of cortical defects or osteolysis and within 3 days after PVP to observe the distribution of polymethylmethacrylate (PMMA) in vertebrae and whether leakage occurred. Volume of PMMA injected into each vertebral body and types of cement leakage were compared between the OVCF and VM groups by Z test or χ². The correlation between cortical defects and cement leakages around vertebrae was assessed with Pearson correlation coefficient.
The successful rate of PVP was 100%. The mean volume of PMMA injected into each vertebra was (5.0 ± 2.0) ml and (4.0 ± 1.7) ml in the OVCF and VM groups respectively (P < 0.05). Asymptomatic PMMA leakage was demonstrated by CT in 93 vertebrae (21.2%) in the OVCF group and in 53 vertebrae (28.8%) in the VM group respectively (P < 0.05). Cement leakages into disk were found in 58 vertebrae in the OVCF group and 16 vertebrae in the VM group respectively (P = 0.025). Cement leakages into paravertebral vein were found in 12 vertebrae in the OVCF group and 26 vertebrae in the VM group respectively (P < 0.0001). Correlation was found between cortical defects and cement leakage into paravertebral soft tissues in the OVCF group (r = 0.14) or in the VM group (r = 0.27), between end-plate defects and cement leakage into disk in the OVCF group (r = 0.29) or in the VM group (r = 0.31).
As a common occurrence in vertebroplasty, cement extravasation is well-tolerated in most patients. It occurs more frequently in the patients with VM than those with OVCF, especially in cases of leakage into paravertebral vein. Cement leakage into disc or paravertebral soft tissue is predisposed in vertebrae with end plate, cortical defects or osteolysis.
评估椎体成形术治疗骨质疏松性椎体压缩骨折（OVCF）及椎体转移瘤（VM）时骨水泥渗漏的影响因素。
对2007年5月至2011年1月在我院接受椎体成形术的356例患者的653个椎体进行回顾性分析。251例患者有438个椎体为疼痛性OVCF，105例患者有215个椎体为VM。术前进行计算机断层扫描（CT）以确定是否存在皮质缺损或骨质溶解，并在经皮椎体成形术（PVP）后3天内观察聚甲基丙烯酸甲酯（PMMA）在椎体内的分布情况以及是否发生渗漏。通过Z检验或χ²检验比较OVCF组和VM组每个椎体注入的PMMA体积以及骨水泥渗漏的类型。采用Pearson相关系数评估皮质缺损与椎体周围骨水泥渗漏之间的相关性。
PVP成功率为100%。OVCF组和VM组每个椎体注入PMMA的平均体积分别为（5.0±2.0）ml和（4.0±1.7）ml（P<0.05）。CT显示OVCF组93个椎体（21.2%）和VM组53个椎体（28.8%）有无症状性PMMA渗漏（P<0.05）。OVCF组58个椎体和VM组16个椎体发现骨水泥渗漏至椎间盘（P=0.025）。OVCF组12个椎体和VM组26个椎体发现骨水泥渗漏至椎旁静脉（P<0.0001）。在OVCF组（r=0.14）或VM组（r=0.27）中，发现皮质缺损与骨水泥渗漏至椎旁软组织之间存在相关性，在OVCF组（r=0.29）或VM组（r=0.31）中，发现终板缺损与骨水泥渗漏至椎间盘之间存在相关性。
作为椎体成形术中的常见情况，大多数患者对骨水泥外渗耐受性良好。VM患者比OVCF患者更常发生骨水泥外渗，尤其是渗漏至椎旁静脉的情况。终板、皮质缺损或骨质溶解的椎体更容易发生骨水泥渗漏至椎间盘或椎旁软组织。
