经皮椎体后凸成形术治疗Kümmell病术中骨水泥渗漏的危险因素分析

Analysis on the risk factors of cement leakage in percutaneous kyphoplasty for Kümmell disease

中文关键词:  经皮椎体后凸成形术  Kümmell病  骨水泥渗漏  危险因素

英文关键词:Percutaneous kyphoplasty  Kümmell disease  Bone cement leakage  Risk factors

中文摘要:

  【摘要】 目的：探讨Kümmell病患者行经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）术中骨水泥渗漏的危险因素。方法：回顾性研究2016年2月~2021年3月在我院行PKP治疗的Kümmell病患者共70例，根据术后是否发现骨水泥渗漏分为渗漏组与非渗漏组，记录两组患者年龄、性别、身体质量指数（body mass index，BMI）、Kümmell病分期（Ⅰ/Ⅱ期）、症状持续时间、骨折部位（胸椎/腰椎）、骨水泥注射量、骨水泥分布形态（团块样/海绵样）、椎体前壁高度丢失值、椎体前壁压缩程度、椎体楔形角、椎体前壁高度、椎体后壁高度和骨水泥体积分数。应用单因素分析及多因素Logistic回归分析研究各因素与骨水泥渗漏之间的关系，并绘制受试者工作特征（receiver operating characteristic，ROC）曲线分析骨水泥体积分数对骨水泥渗漏的预测价值。结果：70例患者中出现骨水泥渗漏32例，渗漏率为45.7%。单因素分析显示，Kümmell病分期、椎体前壁压缩程度、椎体楔形角及骨水泥体积分数组间差异有统计学意义（P<0.05）。多因素Logistic回归分析显示，椎体前壁压缩程度（P=0.021）及骨水泥体积分数（P=0.032）是PKP治疗Kümmell病术中发生骨水泥渗漏的危险因素。ROC曲线显示，骨水泥体积分数预测骨水泥渗漏最佳临界值为31.28%。结论：骨水泥体积分数及椎体前壁压缩程度是PKP治疗Kümmell病术中骨水泥渗漏的独立危险因素，治疗时应保持骨水泥体积分数在31.28%以下。

英文摘要:

  【Abstract】 Objectives: To identify the risk factors of bone cement leakage in percutaneous kyphoplasty (PKP) in patients with Kümmell disease. Methods: A total of 70 patients with Kümmell disease treated with PKP in our hospital between February 2016 and March 2021 were retrospectively reviewed. According to whether there was bone cement leakage in operation or not, the patients were divided into leakage group and non-leakage group. Age, gender, body mass index(BMI), staging of Kümmell disease(Ⅰ/Ⅱ), symptom duration, fracture site(thoracic, lumbar), cement volume, cement distribution pattern (lumped, spongy), anterior and posterior wall heights, the decrease of anterior vertebral wall height, compression degree of anterior wall, wedge angle and the volume fraction of bone cement were recorded. The data were analyzed by univariate and multivariate Logistic regression analysis to determine the related factors of cement leakage. Receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of bone cement volume fraction on bone cement leakage. Results: Bone cement leakage occurred in 32 of 70 patients, with a leakage rate of 45.7%. Univariate analysis showed that there were significant differences in the staging of Kümmell disease(Ⅰ/Ⅱ), the compression degree of anterior wall, wedge angle, and the volume fraction of bone cement between groups(P<0.05). Logistic regression analysis showed that the compression degree of anterior wall(P=0.021) and the volume fraction of bone cement(P=0.032) were the risk factors of bone cement leakage after PKP treatment of Kümmell disease. ROC curve showed that the best critical value of the volume fraction of bone cement to predict bone cement leakage was 31.28%. Conclusions: The compression degree of anterior wall and the volume fraction of bone cement are independent risk factors for bone cement leakage in PKP treatment of Kümmell disease, and the volume fraction of bone cement should be kept below 31.28%.