Department of Orthopaedics, Peking University First Hospital, Beijing, China.
Department of Orthopaedics, Peking University First Hospital, Beijing, China.
J Orthop Sci. 2022 Jan;27(1):79-83. doi: 10.1016/j.jos.2020.10.004. Epub 2020 Nov 4.
The study aimed to identify the risk factors of cement leakage following percutaneous vertebroplasty for spinal metastases.
230 consecutive patients with 530 vertebrae were retrospectively reviewed. Characteristics including age, primary cancer, location, pathological fracture, the integrity of the posterior wall, and the volume of bone cement were considered as potential risk factors. Cement leakage was evaluated by postoperative imaging examination and classified into three subtypes with different potential sequelae: spinal canal leakage, intravascular leakage around vertebrae, intradiscal and paravertebral leakage. Univariate and multivariate analyses were used to assess the risk factors.
Leakage was detected in 185 vertebrae (34.9%), 18.3% for intradiscal and paravertebral, 13.2% for intravascular around vertebrae, and 7.0% for spinal canal. Multivariate analysis showed that incomplete posterior wall (P = 0.001) and breast cancer (P = 0.015) were strong predictive factors for spinal canal leakage, incomplete posterior wall (P = 0.024) was for intravascular leakage around vertebrae, thoracic (P = 0.010) and pathological fracture (P = 0.000) were for intradiscal and paravertebral leakage.
Our findings suggest that cement leakage is common following percutaneous vertebroplasty for spinal metastases. The incomplete posterior wall is an unfavourable factor for intravascular leakage around vertebrae. Vertebrae with incomplete posterior wall and breast cancer metastases are more likely to develop spinal canal leakage.
本研究旨在确定脊柱转移瘤经皮椎体成形术后水泥渗漏的危险因素。
回顾性分析 230 例 530 个椎体的连续患者。将年龄、原发癌、部位、病理骨折、后墙完整性、骨水泥体积等特征作为潜在危险因素进行分析。通过术后影像学检查评估水泥渗漏，并将其分为三种不同潜在并发症的亚型：椎管渗漏、椎骨周围血管内渗漏、椎间盘内和椎旁渗漏。采用单因素和多因素分析评估危险因素。
185 个椎体（34.9%）发现渗漏，其中椎间盘内和椎旁渗漏占 18.3%，椎骨周围血管内渗漏占 13.2%，椎管渗漏占 7.0%。多因素分析显示，不完全后墙（P=0.001）和乳腺癌（P=0.015）是椎管渗漏的强预测因素，不完全后墙（P=0.024）是椎骨周围血管内渗漏的预测因素，胸（P=0.010）和病理性骨折（P=0.000）是椎间盘内和椎旁渗漏的预测因素。
我们的研究结果表明，脊柱转移瘤经皮椎体成形术后水泥渗漏较为常见。不完全后墙是椎骨周围血管内渗漏的不利因素。后墙不完整且乳腺癌转移的椎体更有可能发生椎管渗漏。
