Liu Yao-Yao, Xiao Jun, He Lei, Yin Xiang, Song Lei, Zhou Rui, Zeng Jing, Liu Peng, Dai Fei
Department of Spine Surgery, Daping Hospital, Army Medical Center of PLA, Chongqing, 400042, PR China.
Guangzhou Rocket Force Special Service Convalescent Center, Guangzhou, 510515, PR China.
Heliyon. 2023 Apr 3;9(4):e15167. doi: 10.1016/j.heliyon.2023.e15167. eCollection 2023 Apr.
To investigate the risk factors of cement leakage (CL) for polymethylmethacrylate-augmented cannulated pedicle screw (CPS) in spinal degenerative diseases and provided technical guidance for clinical surgery.
This study enrolled 276 patients with spinal degenerative disease and osteoporosis who were augmented using CPSs (835 screws in total) from May 2011 to June 2018 in our hospital. The patients' age, sex, bone mineral density (BMD), diagnosis, augmented positions, number of CPS implanted, and CL during surgery were recorded. CL was observed by postoperative computed tomography (CT) and was classified by Yeom typing.
A total of 74 (74/835, 8.9%) CPSs in 64 patients leaked (64/276, 23.2%). CL was significantly correlated with the number and position of screws (P < 0.05), but not with sex, age, and BMD (P > 0.05). The position, number of CPSs, fracture, degenerative scoliosis, ankylosing spondylitis, and revision surgery were risk factors for CL (P < 0.05). Augmentation of the thoracic vertebral body, fracture, and ankylosing spondylitis were independent risk factors for Type S. Augmentation of the lumbar vertebral body, lumbar disc herniation, and lumbar spondylolisthesis were independent risk factors for Type B (P < 0.05).
CL has a high incidence in clinical practice. High-risk factors for leakage should be addressed to avoid serious complications. Particularly, it is necessary to develop alternative solutions once CPSs can't be used in surgery caused by CL.
探讨聚甲基丙烯酸甲酯增强型空心椎弓根螺钉（CPS）在脊柱退行性疾病中发生骨水泥渗漏（CL）的危险因素，为临床手术提供技术指导。
本研究纳入了2011年5月至2018年6月在我院采用CPS进行增强治疗的276例脊柱退行性疾病合并骨质疏松患者（共835枚螺钉）。记录患者的年龄、性别、骨密度（BMD）、诊断、增强部位、植入CPS的数量以及手术过程中的CL情况。术后通过计算机断层扫描（CT）观察CL情况，并根据Yeom分型进行分类。
64例患者的74枚（74/835，8.9%）CPS发生渗漏（64/276，23.2%）。CL与螺钉数量和位置显著相关（P<0.05），但与性别、年龄和BMD无关（P>0.05）。CPS的位置、数量、骨折、退行性脊柱侧凸、强直性脊柱炎和翻修手术是CL的危险因素（P<0.05）。胸椎椎体增强、骨折和强直性脊柱炎是S型的独立危险因素。腰椎椎体增强、腰椎间盘突出症和腰椎滑脱是B型的独立危险因素（P<0.05）。
CL在临床实践中发生率较高。应关注渗漏的高危因素以避免严重并发症。特别是，一旦因CL导致手术无法使用CPS，有必要开发替代解决方案。
