Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2024 Mar;85(2):117-125. doi: 10.1055/s-0043-1761943. Epub 2023 Feb 24.
The global trend toward increased life expectancy because of remarkable improvements in health care quality has drawn increased attention to osteoporotic fractures and degenerative spine diseases. Cement-augmented pedicle screw fixation has been established as the mainstay treatment for patients with poor bone quality. This study aimed to determine the number of patients with cement leakage and pulmonary cement embolism (PCE) as detected on thoracic computed tomography (CT), and to assess the potential risk factors for PCE.
Patients undergoing cement-augmented pedicle screw placement in our institution between May 2008 and December 2020 were included. Data regarding baseline characteristics, complications, and cement leakage rates were collected. Indications for the performance of a postoperative thoracic CT due to the suspicion of PCE were intra- or postoperative complications, or postoperative oxygen supplementation. Moreover, PCE was accidently diagnosed because the thoracic CT was performed for medical reasons other than the suspicion of PCE (tumor staging, severe pneumonia, or exacerbated chronic pulmonary obstructive disease).
A total of 104 patients with a mean age of 72.8 years (standard deviation of 6.7) were included. Of 802 screws, 573 were cement augmented. Of the 104 patients, 44 (42.3%) underwent thoracic CT scans to diagnose PCE; additionally, 67 (64.4%) demonstrated cement leakage, of whom 27 developed PCE and 4 were symptomatic. Cement-augmented thoracic screws were a risk factor for PCE (odds ratio: 1.5; 95% confidence interval: 1.2-2.1; = 0.004).
This study showed a high prevalence of cement leakage after cement-augmented pedicle screw insertion, with a relatively frequent incidence of PCE, as tracked by thoracic CT scans. Cement-augmented thoracic screw placement was a unique risk factor for PCE.
由于医疗质量的显著改善，全球预期寿命呈增长趋势，这使得人们对骨质疏松性骨折和退行性脊柱疾病的关注度越来越高。骨水泥增强椎弓根螺钉固定已成为治疗骨质量差的患者的主要方法。本研究旨在确定通过胸部计算机断层扫描（CT）检测到的骨水泥渗漏和肺水泥栓塞（PCE）的患者数量，并评估 PCE 的潜在危险因素。
纳入 2008 年 5 月至 2020 年 12 月期间在我院行骨水泥增强椎弓根螺钉固定的患者。收集了患者的基线特征、并发症和骨水泥渗漏率的数据。进行术后胸部 CT 的指征为怀疑发生 PCE 的围手术期并发症或术后氧疗。此外，由于怀疑 PCE 以外的其他原因（肿瘤分期、严重肺炎或加重的慢性阻塞性肺疾病）进行胸部 CT 检查，意外诊断出 PCE。
共纳入 104 例平均年龄为 72.8 岁（标准差为 6.7）的患者。在 802 枚螺钉中，573 枚螺钉进行了骨水泥增强。104 例患者中，44 例（42.3%）行胸部 CT 扫描以诊断 PCE；此外，67 例（64.4%）显示骨水泥渗漏，其中 27 例发生 PCE，4 例有症状。骨水泥增强的胸椎螺钉是 PCE 的危险因素（比值比：1.5；95%置信区间：1.2-2.1；=0.004）。
本研究显示，骨水泥增强椎弓根螺钉置入后骨水泥渗漏发生率较高，通过胸部 CT 扫描发现 PCE 发生率相对较高。骨水泥增强的胸椎螺钉放置是 PCE 的一个独特危险因素。
