Tomé-Bermejo Félix, Piñera Angel R, Duran-Álvarez Carmen, Román Belén López-San, Mahillo Ignacio, Alvarez Luis, Pérez-Higueras Antonio
Spine Department.
Department of Epidemiology.
Spine (Phila Pa 1976). 2014 May 15;39(11):E693-E700. doi: 10.1097/BRS.0000000000000294.
Retrospective study.
To identify fracture morphology-dependent risk factors for the occurrence of cement leakage during percutaneous vertebroplasty.
Extravertebral cement leakage is the most frequently reported complication and represents a major risk after vertebroplasty and balloon kyphoplasty. Despite the frequent occurrence of cement leakage and potentially dangerous complications and sequelae, there are few reports that examine its predictors.
Retrospective review of 194 consecutive patients who underwent percutaneous vertebroplasty for painful osteoporotic or malignant vertebral fracture. The influences of several parameters that might affect the occurrence of cement leakage were assessed using univariate and multivariate analyses. Cement leakage was assessed using computed tomography scanning and classified into 4 different types with different potential sequelae: through the basivertebral vein, through the segmental vein, through a cortical defect, and intradiscal leakage.
Leakage of cement was detected in 209 of the 272 treated vertebrae (76.83%). The most common types of leakage detected were through the basivertebral vein (43.38%) and the segmental vein (42.27%). None of the evaluated variables showed a statistically significant effect. Only the absence of Kummell disease (P = 0.063) and a lower severity grade of collapse (P = 0.068) approached statistical significance. For basivertebral vein leakages, the location at the thoracolumbar level and the absence of Kummell disease (P < 0.05) were strong predictive factors for cement leakages. For segmental vein leakages, the odds decreased as the severity grade of collapse increased (P = 0.008).
Each different vertebral fracture pattern has its own risk factors for cement leakage. For certain types of leakage, Kummell avascular necrosis as a protective factor and fracture severity grade with paradoxical effect have each demonstrated influence in the occurrence of cement leakage.
回顾性研究。
确定经皮椎体成形术中骨水泥渗漏发生的骨折形态相关危险因素。
椎体外骨水泥渗漏是最常报道的并发症，是椎体成形术和球囊后凸成形术后的主要风险。尽管骨水泥渗漏频繁发生且可能导致危险的并发症和后遗症，但很少有报告研究其预测因素。
回顾性分析194例因骨质疏松性或恶性椎体骨折疼痛而接受经皮椎体成形术的连续患者。使用单因素和多因素分析评估可能影响骨水泥渗漏发生的几个参数的影响。使用计算机断层扫描评估骨水泥渗漏，并分为具有不同潜在后遗症的4种不同类型：通过椎基静脉、通过节段静脉、通过皮质缺损和椎间盘内渗漏。
在272个治疗椎体中的209个（76.83%）检测到骨水泥渗漏。检测到的最常见渗漏类型是通过椎基静脉（43.38%）和节段静脉（42.27%）。评估的变量均未显示出统计学上的显著影响。只有不存在Kummell病（P = 0.063）和较低的塌陷严重程度分级（P = 0.068）接近统计学意义。对于椎基静脉渗漏，胸腰段水平的位置和不存在Kummell病（P < 0.05）是骨水泥渗漏的强预测因素。对于节段静脉渗漏，随着塌陷严重程度分级增加，发生几率降低（P = 0.008）。
每种不同的椎体骨折模式都有其自身的骨水泥渗漏危险因素。对于某些类型的渗漏，Kummell缺血性坏死作为保护因素以及具有矛盾效应的骨折严重程度分级均对骨水泥渗漏的发生有影响。
4级。
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