[1]刘锐,龚德飞,班正涛,等.经皮椎体成形术治疗骨质疏松性椎体压缩骨折术中骨水泥渗漏的危险因素分析[J].中医正骨,2022,34(11):14-17，26.
　LIU Rui,GONG Defei,BAN Zhengtao,et al.Risk factors for bone cement leakage during percutaneous vertebroplasty treatment of osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(11):14-17，26.
点击复制

经皮椎体成形术治疗骨质疏松性椎体压缩骨折术中骨水泥渗漏的危险因素分析()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年11期
页码:
14-17，26
栏目:
临床研究
出版日期:
2022-11-11

文章信息/Info

Title:
Risk factors for bone cement leakage during percutaneous vertebroplasty treatment of osteoporotic vertebral compression fractures
作者:
刘锐1; 龚德飞1; 班正涛1; 刘汝专1; 黄民锋1; 魏纪湖2; 李沛桢2; 周华亮2
(1.广西中医药大学附属瑞康医院,广西 南宁 530011; 2.广西中医药大学研究生院,广西 南宁 530001)
Author(s):
LIU Rui1; GONG Defei1; BAN Zhengtao1; LIU Ruzhuan1; HUANG Minfeng1; WEI Jihu2; LI Peizhen2; ZHOU Hualiang2
1.Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine,Nanning 530011,Guangxi,China 2.Graduate School of Guangxi University of Traditional Chinese Medicine,Nanning 530001,Guangxi,China
关键词:
骨质疏松性骨折;  脊柱骨折;  骨折; 压缩性;  椎体成形术;  手术中并发症;  骨粘合剂;  危险因素;  Logistic模型
Keywords:
osteoporotic fractures;  spinal fractures;  fractures; compression;  vertebroplasty;  intraoperative complications;  bone cements;  risk factors;  logistic models
摘要:
目的:分析经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)术中骨水泥渗漏的危险因素。方法:选择2017年6月至2021年6月采用PVP治疗的307例OVCF患者,从病历系统中收集患者的年龄、性别、病程、外伤史、基础疾病(高血压、糖尿病)、骨折节段、椎体骨折类型、椎体压缩程度、椎体后缘骨质是否突入椎管、椎体裂隙征、单侧或双侧穿刺、一次治疗椎体数量、单个椎体骨水泥注射量、骨水泥弥散类型、手术时间、骨水泥是否渗漏等信息。先进行单因素Logistic回归分析,再将单因素分析结果中P<0.150的变量作为自变量进行多因素Logistic回归分析。结果:307例OVCF患者共涉及371椎,其中195椎发生骨水泥渗漏、176椎未发生骨水泥渗漏。单因素Logistic回归分析结果显示,年龄(P=0.118)、基础疾病(高血压、糖尿病)(P=0.109)、骨水泥弥散类型(P=0.003)、手术时间(P=0.005)、椎体压缩程度(P=0.012)可作为多因素分析的自变量。多因素Logistic回归分析结果显示,骨水泥弥散类型为弥散型、手术时间<40 min是PVP治疗OVCF术中骨水泥渗漏的独立危险因素[B=0.636,P=0.009,OR=1.899,95%CI(1.171,3.047); B=0.574,P=0.015,OR=1.776,95%CI(1.118,2.820)]。结论:手术时间<40 min、骨水泥呈弥散型分布是PVP治疗OVCF术中骨水泥渗漏的独立危险因素。
Abstract:
Objective:To investigate the risk factors for bone cement leakage during percutaneous vertebroplasty(PVP)for treatment of osteoporotic vertebral compression fractures(OVCF).Methods:Three hundred and seven OVCF patients treated with PVP from June 2017 to June 2021 were included retrospectively.Through the medical records systems,the information of age,gender,disease course,trauma history,underlying disease(hypertension and diabetes),fracture segment,vertebral fracture type,vertebral compression degree,osteophyte protruding into vertebral canal,intravertebral cleft,puncture method(unilateral or bilateral),number of vertebral body treated at one time,amount of bone cement for single vertebral body,cement distribution type,duration of surgery,and cement leakage were collected.Univariate logistic regression analysis was performed first,and variables with a P value of<0.150 were further regarded as independent variables for multivariate logistic regression analysis.Results:The 307 OVCF cases involved 371 vertebral bodies,in which 195 vertebral bodies presented cement leakage and 176 did not.The results of univariate logistic regression showed that age(P=0.118),underlying disease(hypertension and diabetes)(P=0.109),bone cement distribution type(P=0.003),duration of surgery(P=0.005),and vertebral compression degree(P=0.012)met the requirements of being the independent variables for multivariate logistic regression analysis.The results of multivariate logistic regression analysis showed that diffuse distribution of bone cement and shortened duration of surgery(less than 40 min)were independent risk factors for bone cement leakage during PVP treatment of OVCF(B=0.636,P=0.009,OR=1.899,95%CI(1.171,3.047); B=0.574,P=0.015,OR=1.776,95%CI(1.118,2.820)).Conclusion:Shortened duration of surgery(less than 40 min)and diffuse distribution of bone cement are independent risk factors for bone cement leakage during PVP treatment of OVCF.

参考文献/References:

[1] MITCHELL B D,STREETEN E A.Clinical impact of recent genetic discoveries in osteoporosis[J].Appl Clin Genet,2013,6:75-85.
[2] 刘晨,胡铖哲,尹逊,等.骨质疏松性胸腰椎压缩骨折经皮椎体强化治疗后残余痛的危险因素[J].中国组织工程研究,2022,26(18):2900-2905.
[3] 闫福栋,孙章萍,毕研,等.经皮椎体成形术与保守治疗骨质疏松性椎体压缩骨折的临床疗效[J].黑龙江医药,2021,34(4):923-925.
[4] BUCHBINDER R,JOHNSTON R V,RISCHIN K J,et al.Percutaneous vertebroplasty for osteoporotic vertebral compression fracture[J].Cochrane Database Syst Rev,2018,4(4):CD006349.
[5] FAN X,LI S,ZENG X,et al.Risk factors for thoracolumbar pain following percutaneous vertebroplasty for osteoporotic vertebral compression fractures[J].J Int Med Res,2021,49(1):300060521989468.
[6] 印平,马远征,马迅,等.骨质疏松性椎体压缩性骨折的治疗指南[J].中国骨质疏松杂志,2015,21(6):643-648.
[7] 中华医学会,中华医学会杂志社,中华医学会全科医学分会,等.原发性骨质疏松症基层诊疗指南(2019年)[J].中华全科医师杂志,2020,19(4):304-315.
[8] 吴爱悯,倪文飞,池永龙.椎体内裂隙征的形成机理、影像学特征及手术治疗[J].脊柱外科杂志,2012,10(1):56-59.
[9] 赵永生,李强,历强,等.骨水泥弥散类型对治疗骨质疏松性椎体压缩骨折的影响[J].中国骨伤,2017,30(5):446-452.
[10] 中华医学会,中华医学会临床药学分会,中华医学会杂志社,等.骨质疏松症基层合理用药指南[J].中华全科医师杂志,2021,20(5):523-529.
[11] 《中成药治疗优势病种临床应用指南》标准化项目组.中成药治疗骨质疏松症临床应用指南(2021年)[J].中国中西医结合杂志,2022,42(4):393-404.
[12] CHEN Z,CHEN Z,WU Y,et al.Risk factors of secondary vertebral compression fracture after percutaneous vertebroplasty or kyphoplasty:a retrospective study of 650 patients[J].Med Sci Monit,2019,25:9255-9261.
[13] 熊巍,王贵梅.不同卧床时间对老年骨质疏松性椎体压缩骨折的疗效影响[J].颈腰痛杂志,2021,42(6):850-852.
[14] AL-NAKSHABANDI N A.Percutaneous vertebroplasty complications[J].Ann Saudi Med,31(3):294-297.
[15] 李文乐,王浩胜,宁丽俊,等.骨质疏松患者经皮椎体成形后骨水泥渗漏风险分析及预测模型验证[J].中国组织工程研究,2022,26(10):1549-1554.
[16] 崔利宾,唐本强,王彦辉,等.年龄≥80岁骨质疏松性椎体压缩骨折患者经皮椎体成形术骨水泥渗漏的危险因素分析[J].中国脊柱脊髓杂志,2020,30(6):530-538.
[17] 徐耀宁,曹振文,池科德,等.老年骨质疏松性腰椎压缩性骨折患者PVP术中骨水泥渗漏发生情况及其影响因素分析[J].临床医学工程,2021,28(10):1439-1440.
[18] 王龙,李续,杨治涛,等.骨质疏松性腰椎压缩骨折行椎体成形术后骨水泥渗漏的危险因素分析[J].颈腰痛杂志,2021,42(5):744-746.
[19] 贾鑫,史婧,韩风,等.经皮椎体成形术骨水泥渗漏的术前危险因素分析[J].临床放射学杂志,2018,37(12):2085-2090.
[20] ZHAN Y,JIANG J,LIAO H,et al.Risk factors for cement leakage after vertebroplasty or kyphoplasty:a meta-analysis of published evidence[J].World Neurosurg,2017,101:633-642.

相似文献/References:

[1]张亮,张莉,王莉佳,等.快速康复外科理念在椎弓根螺钉内固定治疗 胸腰椎骨折围手术期护理中的应用[J].中医正骨,2015,27(06):75.
[2]潘雄,刘其顺,应行,等.中药联合4步康复锻炼法对骨质疏松性椎体压缩 骨折患者生存质量的影响[J].中医正骨,2015,27(04):65.
[3]宋永枝,陈双玲.唑来膦酸静脉滴注联合鲑降钙素肌肉注射治疗 骨质疏松性长骨骨折[J].中医正骨,2016,28(01):70.
[4]孙兰芬,王龙强,刘润宏,等.颈椎骨折脱位合并脊髓损伤截瘫患者的围手术期护理[J].中医正骨,2016,28(03):79.
[5]吴鹏,王博,孔令成,等.强骨饮颗粒联合阿仑膦酸钠维D3片口服在原发性骨质疏松性髋部骨折术后抗骨质疏松治疗中的应用[J].中医正骨,2016,28(05):16.
　WU Peng,WANG Bo,KONG Lingcheng,et al.Oral application of Qiangguyin Keli(强骨饮颗粒)and alendronate sodium Vitamin D3 tablets in postoperative anti-osteoporosis treatment in patients with primary osteoporotic hip fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(11):16.
[6]梅 伟.胸腰椎骨折临床诊疗中的热点问题[J].中医正骨,2016,28(07):1.
[7]徐无忌,刘晓岚.体位复位结合经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的对比研究[J].中医正骨,2016,28(07):20.
　XU Wuji,LIU Xiaolan.Effect of Qianggu Yin(强骨饮,QGY)on bone microstructure in the ovariectomized osteoporosis rats[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(11):20.
[8]李英周,叶锋,王晓,等.后路撬拨植骨椎弓根螺钉内固定治疗胸腰椎骨折[J].中医正骨,2016,28(07):46.
[9]王军,陈哲,王硕凡.胸腰椎骨折椎体植骨材料的临床应用进展[J].中医正骨,2016,28(07):64.
[10]史晓林,王健,王博,等.脆性骨折的防治进展[J].中医正骨,2017,29(05):20.
[11]陈建德,樊晓琦,夏炳江,等.球囊扩张部位对椎体后凸成形术治疗骨质疏松性椎体压缩骨折疗效及安全性的影响[J].中医正骨,2017,29(02):11.
　CHEN Jiande,FAN Xiaoqi,XIA Bingjiang,et al.Influence of balloon dilation position on curative effect and safety of percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(11):11.
[12]丁志清,颜峰,喻灿明,等.椎体后凸成形术后非典型骨水泥植入综合征死亡1例[J].中医正骨,2017,29(11):76.
[13]俞兴,王婷,杨济洲,等.经皮椎体成形术和经皮椎体后凸成形术治疗Kmmell病的对比研究[J].中医正骨,2018,30(06):23.
　YU Xing,WANG Ting,YANG Jizhou,et al.A retrospective trial of percutaneous vertebroplasty versus percutaneous kyphoplasty for treatment of Kmmell's diseases[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(11):23.
[14]彭小东,张晓刚,赵文韬,等.有限元分析在过伸复位治疗骨质疏松性椎体压缩性骨折生物力学研究中的应用进展[J].中医正骨,2018,30(07):25.
[15]陈建德,樊晓琦,凌义龙.单侧椎弓根旁外侧入路与双侧椎弓根入路 经皮椎体后凸成形术治疗骨质疏松性胸椎 压缩性骨折的对比研究[J].中医正骨,2018,30(10):19.
　CHEN Jiande,FAN Xiaoqi,LING Yilong.A retrospective trial of percutaneous kyphoplasty through unilateral extrapedicular approach versus bilateral transpedicular approach for treatment of thoracic osteoporotic vertebral compression fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(11):19.
[16]于东方,王祥善,张华,等.经皮椎体成形术后手术椎体再骨折的病因、治疗及预防[J].中医正骨,2018,30(10):69.
[17]李兆勇,杨少锋,张晨阳.补肾活血方联合经皮椎体强化术治疗骨质疏松性椎体压缩骨折的系统评价[J].中医正骨,2019,31(03):28.
　LI Zhaoyong,YANG Shaofeng,ZHANG Chenyang.Oral application of Bushen Huoxue Fang(补肾活血方)combined with percutaneous vertebral augmentation for treatment of osteoporotic vertebral compression fractures:a systematic review[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(11):28.
[18]杨磊,崔宏勋,饶耀剑,等.弯角穿刺椎体成形装置辅助下单侧穿刺经皮椎体成形术治疗骨质疏松性椎体压缩骨折[J].中医正骨,2020,32(01):64.
[19]陈晨,安忠诚,张英健,等.椎体强化术后残留腰背痛的研究进展[J].中医正骨,2020,32(05):26.
[20]罗金金,丁彩田.骨质疏松性椎体压缩骨折经皮椎体后凸成形术后脊柱后凸畸形改善程度的影响因素分析[J].中医正骨,2022,34(08):8.
　LUO Jinjin,DING Caitian.Analysis of factors influencing the degree of improvement of spinal kyphosis deformity after percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(11):8.

备注/Memo

备注/Memo:
基金项目:广西壮族自治区中医药管理局自筹经费科研课题(GXZYZ20210157) 通讯作者:龚德飞 E-mail:147508208@qq.com
更新日期/Last Update: 1900-01-01