经皮椎体强化术后骨水泥椎间盘渗漏与邻近椎体骨折的相关性分析

The correlation analysis of intradiscal cemment leakage and adjacent vertebral fracture after percutaneous vertebral augmentation

中文关键词:  骨质疏松性椎体压缩骨折  经皮椎体成形术  经皮椎体后凸成形术  骨水泥椎间盘渗漏  邻近椎体骨折

英文关键词:Osteoporotic vertebral compression fractures  Percutaneous vertebroplasty  Percutaneous kyphoplasty  Intradiscal cemment leakage  Adjacent vertebral fracture

中文摘要:

  【摘要】 目的：探讨经皮椎体强化（percutaneous vertebral augmentation，PVA）术后骨水泥椎间盘渗漏与邻近椎体骨折（adjacent vertebral fracture，AVF）的相关性，分析骨水泥椎间盘渗漏的位置及渗漏量对AVF的影响。方法：对151例经PVA治疗的骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture，OVCF）患者进行随访研究，随访1~3年，获取患者年龄、性别、手术椎体部位、手术方式及骨水泥注入量等临床资料，记录PVA术中是否存在骨水泥椎间盘渗漏、渗漏位置，计算骨水泥-椎间盘相对面积比，分析上述各因素与AVF的相关性，应用ROC曲线检验骨水泥注入量及骨水泥-椎间盘相对面积比对AVF的预测效能，采用二分类Logistics回归模型分析AVF的相关危险因素。结果：151例患者手术椎体共192节，55节在PVA时发生了骨水泥渗漏（55/192，28.6%），其中23节发生AVF；137节无骨水泥椎间盘渗漏，其中32节发生AVF，骨水泥渗漏与无骨水泥渗漏AVF的发生率有统计学差异（41.8% vs 20.4%，P=0.002）。AVF组骨水泥-椎间盘相对面积比为（24.4±11.0）%，无AVF组的骨水泥-椎间盘相对面积比为（13.7%±9.3%），两组比较差异有统计学意义（P<0.001）。骨水泥-椎间盘相对面积比的ROC曲线下面积为0.807，骨水泥-椎间盘相对面积取值为16.1%时，其预测AVF的敏感性为87.0%，特异性为72.2%。AVF组的年龄为75.8±7.8岁，高于无AVF组的73.0±8.3岁（P=0.036）。110节椎体骨水泥注入量<5ml，其中22节发生AVF，骨水泥注入量≥5ml的82节椎体有29节发生AVF，两组AVF发生率比较有统计学差异（20.0% vs 35.4%，P=0.017）。骨水泥注入量的ROC曲线下面积为0.537，取骨水泥注入量5.25ml作为阈值时，其预测AVF的敏感性为58.3%，特异性为63.9%。二分类Logistics回归模型多因素分析结果显示，年龄及骨水泥-椎间盘相对面积比是AVF的独立危险因素（P<0.05）。结论：骨水泥椎间盘渗漏是AVF的重要危险因素之一，且与渗漏至椎间盘的骨水泥量呈正相关，骨水泥-椎间盘相对面积比对AVF具有较好的预测效能，可作为PVA术后评价AVF风险的参考指标。

英文摘要:

  【Abstract】 Objectives: To assess the correlation between intradiscal cemment leakage and adjacent vertebral fracture(AVF) after percutaneous vertebral augmentation(PVA), and further to determine the effects of cemment leakage location and volume into adjacent discs on AVF. Methods: A total of 151 patients with osteoporotic vertebral compression fracture(OVCF ), who were treated with PVA and followed up for 1 to 3 years, were rolled in this study. The followings were collected: gender, age, location of treated vertebral body, bone cement volume and surgical options. Whether or not intradiscal cemment leakage, leakage location(anterior, middle, or posterior of the adjacent disc), and relative area ratio of leakaged cemment-adjacent disc were evaluated on the post-operative X-ray of thoracic and lumbar spine. The correlations of the above factors and AVF were assessed. The risk factors of AVF were analyzed by using binary logistic regression model. Results: There were 192 vertebrae augmented in 151 cases, and intradiscal cemment leakage were found in 55 vertebrae. The incidence of AVF was 41.8% in intradiscal cemment leakage group and 20.4% in none intradiscal cemment leakage group(P=0.002). The relative area ratio of leakaged cemment-adjacent disc was (24.4±11)% in AVF group and (13.7±9.3)% in none AVF group(P<0.001). The area under the ROC curve of leakaged cemment-adjacent disc relative area ratio for occurrence of AVF was 0.807, with a cut-off value of 16.1%, and the sensitivity was 87.0% and the specificity was 72.2%. The age of AVF group was 75.8±7.8 years, larger than none AVF group 73.0±8.3 years(P=0.036). The incidence of AVF in bone cement volume <5ml and ≥5ml was 20.0% and 35.4% respectively, and the difference was statistically significant(P=0.017). The area under the ROC curve of bone cement volume for occurrence of AVF was 0.537 with a cut-off value of 5.25ml, and the sensitivity was 58.3% and the specificity was 63.9%. There was no statistically significant association of AVF and gender, location of treated vertebral body, surgical approach, location of cemment leakage(P>0.05). The results of binary logistic regression analysis showed that age and relative area ratio of leakaged cemment-adjacent disc were independent risk factors of AVF(P<0.05). Conclusions: Intradiscal cemment leakage is an important risk factor of AVF, which correlates positively with the cement leakage volume into adjacent disc. Reducing or avoiding the cement leakage into adjacent disc during PVA can reduce the risk of AVF. The relative area ratio of leakaged cemment-adjacent disc can predict AVF effectively, and can be an useful tool for evaluating the risk of AVF after PVA.