经皮椎体成形术治疗脊柱转移瘤时的骨水泥渗漏：发病率及危险因素的回顾性评估

Cement leakage in percutaneous vertebroplasty for spinal metastases: a retrospective evaluation of incidence and risk factors.

作者信息

Corcos Gabriel, Dbjay Jonathan, Mastier Charles, Leon Sandrine, Auperin Anne, De Baere Thierry, Deschamps Frédéric

机构信息

Departments of *Interventional Radiology and †Biostatistics, Institut Gustave Roussy, Villejuif, France.

出版信息

Spine (Phila Pa 1976). 2014 Mar 1;39(5):E332-8. doi: 10.1097/BRS.0000000000000134.

DOI:10.1097/BRS.0000000000000134

PMID:24299719

Abstract

STUDY DESIGN

Retrospective assessment of risk factors using univariate and multivariate analyses.

OBJECTIVE

To evaluate risk factors retrospectively for cement leakage (CL), including vascular cement leakage (vCL) and cortical cement leakage (cCL), in percutaneous vertebroplasty of spinal metastasis.

SUMMARY OF BACKGROUND DATA

Complications of vertebroplasty for spine metastasis are rare but related to extravertebral cement leakage that is pulmonary embolism and medullary compression. Better understanding of the risk factors for vascular and cortical types of cement leakage is necessary to prevent these complications.

METHODS

Fifty-six cancer patients (30 females, 26 males; age, 56 ± 12 yr) (81 vertebrae) were treated in 58 sessions under fluoroscopy or computed tomography-fluoroscopy guidance. Leakage rates were reported. The following items were assessed for occurrence of CL, vCL, and cCL: primary tumor site, prior radiotherapy or local tumor ablation or embolization, appearance on computed tomography, cortical osteolytic destruction, vertebral collapse, operator's experience, guidance modality, and cement filling.

RESULTS

CL, vCL, and cCL rates were 53%, 25%, and 32%. History of prior treatment correlated with a decrease in CL (P = 0.018). vCL decreased when lung was the primary tumor site (P = 0.036), in osteolytic vertebrae (P = 0.033) or when there was a vertebral collapse (P = 0.037). cCL correlated with operator's experience (P = 0.021) and vertebral collapse (P < 0.001). Superior discal cCL correlated with superior endplate cortical destruction (P = 0.012). Although history of prior treatment seemed to be an independent protective factor (odds ratio = 0.24; 95% confidence interval, 0.087-0.7; P = 0.001), vertebral collapse was isolated as a risk factor for cCL (odds ratio = 32; 95% confidence interval, 6.7-161; P = 0.001).

CONCLUSION

Risk factors for cCL and vCL are distinct. Vertebral collapse and cortical destruction are risk factors for cCL. History of prior treatment is a protective factor for CL.

LEVEL OF EVIDENCE

摘要

研究设计

采用单因素和多因素分析对危险因素进行回顾性评估。

目的

回顾性评估脊柱转移瘤经皮椎体成形术中骨水泥渗漏（CL）的危险因素，包括血管性骨水泥渗漏（vCL）和皮质骨骨水泥渗漏（cCL）。

背景资料总结

椎体成形术治疗脊柱转移瘤的并发症罕见，但与椎体外骨水泥渗漏有关，即肺栓塞和髓腔受压。更好地了解血管性和皮质性骨水泥渗漏的危险因素对于预防这些并发症很有必要。

方法

56例癌症患者（30例女性，26例男性；年龄56±12岁）（81个椎体）在透视或计算机断层扫描透视引导下接受了58次治疗。报告了渗漏率。对以下项目评估CL、vCL和cCL的发生情况：原发肿瘤部位、既往放疗或局部肿瘤消融或栓塞、计算机断层扫描表现、皮质骨溶骨性破坏、椎体塌陷、术者经验、引导方式和骨水泥填充情况。

结果

CL、vCL和cCL的发生率分别为53%、25%和32%。既往治疗史与CL减少相关（P = 0.018）。当原发肿瘤部位为肺（P = 0.036）、溶骨性椎体（P = 0.033）或存在椎体塌陷（P = 0.037）时，vCL减少。cCL与术者经验（P = 0.021）和椎体塌陷（P < 0.001）相关。上位椎间盘cCL与上位终板皮质破坏相关（P = 0.012）。虽然既往治疗史似乎是一个独立的保护因素（比值比 = 0.24；95%置信区间，0.087 - 0.7；P = 0.001），但椎体塌陷被确定为cCL的危险因素（比值比 = 32；95%置信区间，6.7 - 161；P = 0.001）。