Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China.
The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.
Eur Spine J. 2019 Jul;28(7):1661-1669. doi: 10.1007/s00586-019-05985-4. Epub 2019 Apr 27.
To evaluate the incidence, type and risk factors of cement leakage (CL) with cement-augmented pedicle screw instrumentation (CAPSI) in degenerative lumbosacral disease.
Two hundred and two patients using a total of 950 cement-augmented screws were enrolled. CL was classified into three types: type S: leakage via segmental veins; type B: leakage via basivertebral veins; and type I: leakage via pedicle screw instrumentation to paravertebral soft tissue. The age, gender, operation stage (primary or later stage), body mass index, bone mineral density, the number and type of augmented screw, the position of the tip of screw (lateral or internal part of vertebral body), the position of screw (left or right side), the volume of bone cement, location of the augmented vertebra (lumbar or sacrum), the type of CL and complications were recorded. Binary logistic regression correlation was used to analyze risk factors of veins leakage (type S and type B).
The CL was observed in 165 patients (81.68%) and 335 screws (35.26%), leakage types of S, B and I were seen in 255 (76.12%), 77 (22.99%), and 30 (8.96%) of screws, respectively. Besides, double or multiple routes of leakage were seen in 27 screws. Number of augmented screw was a risk factor for vein leakage (OR 0.58; 95% CI 0.44-0.77; P = 0.000). Furthermore, the doses of cement (OR 0.79; 95% CI 0.61-0.99; P = 0.038) and the position of screw (OR 0.39; 95% CI 0.29-0.53; P = 0.000) were identified as risk factors for type S, and the doses of bone cement (OR 0.37; 95% CI 0.25-0.54; P = 0.000) and the position of the tip of screw (OR 0.07; 95% CI 0.04-0.13; P = 0.000) were risk factors for type B.
CAPSI bears a high risk of asymptomatic CL, with a higher rate of leakage into segmental veins and basivertebral veins. As is known, more augmented screws and larger doses of cement are risk factors for veins leakage (type S and type B), while the tip of screw approaching to the midline of the vertebral body is another risk factor to type B. Thus, the CL could be reduced by the amelioration of operative techniques and procedures. These slides can be retrieved under Electronic Supplementary Material.
评估在退变性腰骶疾病中，使用骨水泥增强椎弓根螺钉固定（CAPSI）时，骨水泥渗漏（CL）的发生率、类型和危险因素。
共纳入 202 例患者，共使用了 950 枚骨水泥增强螺钉。CL 分为 3 型：S 型：通过节段静脉渗漏；B 型：通过基底静脉渗漏；I 型：通过椎弓根螺钉器械渗漏至椎旁软组织。记录年龄、性别、手术阶段（初次或后期）、体重指数、骨密度、增强螺钉的数量和类型、螺钉尖端的位置（椎体的外侧或内侧部分）、螺钉位置（左侧或右侧）、骨水泥体积、增强椎体的位置（腰椎或骶骨）、CL 的类型和并发症。采用二项逻辑回归相关性分析静脉渗漏（S 型和 B 型）的危险因素。
165 例（81.68%）患者和 335 枚螺钉（35.26%）出现 CL，S、B 和 I 型渗漏分别见于 255 枚（76.12%）、77 枚（22.99%）和 30 枚（8.96%）螺钉。此外，27 枚螺钉存在双重或多重渗漏途径。增强螺钉的数量是静脉渗漏的危险因素（OR 0.58；95%CI 0.44-0.77；P=0.000）。此外，骨水泥剂量（OR 0.79；95%CI 0.61-0.99；P=0.038）和螺钉位置（OR 0.39；95%CI 0.29-0.53；P=0.000）被确定为 S 型的危险因素，而骨水泥剂量（OR 0.37；95%CI 0.25-0.54；P=0.000）和螺钉尖端位置（OR 0.07；95%CI 0.04-0.13；P=0.000）是 B 型的危险因素。
CAPSI 发生无症状 CL 的风险较高，节段静脉和基底静脉渗漏的发生率更高。已知，更多的增强螺钉和更大剂量的骨水泥是静脉渗漏（S 型和 B 型）的危险因素，而螺钉尖端接近椎体中线则是 B 型的另一个危险因素。因此，通过改进手术技术和程序可以降低 CL 的发生。这些幻灯片可以在电子补充材料中检索到。
