Efficacy and High-Risk Factors of Cement Leakage in Unilateral and Bilateral Pedicle Approach PVP for Osteoporotic Fractures of the Upper Thoracic Vertebrae
GUO Yifan, CHEN Bo, et al
Shangluo Central Hospital, Shaanxi Shangluo 726000, China
Abstract：Objective: To analyze the therapeutic effect of unilateral and bilateral pedicle approach percutaneous vertebroplasty (PVP) on patients with upper thoracic osteoporotic fractures, and to explore the high-risk factors affecting bone cement leakage.Methods: A retrospective analysis was conducted on 151 patients with osteoporotic fractures of the upper thoracic vertebrae who underwent PVP surgery in our hospital from June 2021 to June 2023. Among them, 80 patients with a unilateral pedicle approach were designated as the unilateral group, and 71 patients with a bilateral pedicle approach were designated as the bilateral group. The surgery time, blood loss, and intraoperative cement leakage rate were compared between the two groups, along with the pain levels 7 days post-operation. Based on the occurrence of intraoperative cement leakage, patients were divided into the leakage group and the non-leakage group. Logistic multivariate analysis was used to identify high-risk factors for cement leakage.Results: Compared with the bilateral group, the unilateral group had shorter surgery time, less blood loss, and a lower rate of intraoperative cement leakage (P<0.05). The pain level in the unilateral group 7 days post-operation was significantly lower than in the bilateral group (P<0.05). Statistically significant differences were observed between the leakage and non-leakage groups in terms of age, cement dispersion type, spinal kyphosis Cobb angle, and endplate/posterior wall integrity (P<0.05). Logistic multivariate analysis revealed that age ≥70 years, dispersive type of cement dispersion, high spinal kyphosis Cobb angle, and incomplete endplate/posterior wall were high-risk factors for intraoperative cement leakage in PVP (P<0.05).Conclusion: The unilateral pedicle approach PVP surgery shows more significant therapeutic effects compared to the bilateral approach. Various factors influence cement leakage during PVP surgery, and clinical practice should include a comprehensive preoperative evaluation of patients' conditions and optimization measures to reduce the incidence of cement leakage.
[1] Lo JC,Yang W,Park-Sigal JJ,et al.Osteoporosis and fracture risk among older US Asian adults[J].Curr Osteoporos Rep,2023,21(5):592-608. [2] 赖居易,谭黄圣,冯华龙,等.机器人辅助经皮椎体成形术治疗上段胸椎骨质疏松性骨折[J].中国骨伤,2023,36(9):859-865. [3] Noguchi T,Yamashita K,Kamei R,et al.Current status and challenges of percutaneous vertebroplasty (PVP) [J].Jpn Radiol,2023,41(1):1-13. [4] 谢胜荣,董迎春,王艳,等.不同穿刺入路经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的疗效对比[J].脊柱外科杂志,2020,18(4):227-231. [5] Dai C,Liang G,Zhang Y,et al.Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures,especially in Eastern Asia:a systematic review and meta-analysis[J].Orthop Surg Res,2022,17(1):161-171. [6] 邱贵兴,裴福兴,胡侦明,等.中国骨质疏松性骨折诊疗指南(全文)(骨质疏松性骨折诊断及治疗原则)[J].中华关节外科杂志,2015,9(6):117-120. [7] Kutsal FY,Ergin Ergani GO.Vertebral compression fractures:Still an unpredictable aspect of osteoporosis[J].Turk Med Sci,2021,51(2):393-399. [8] 唐晓军,罗玲丽,陈小明,等.经皮脊柱内镜治疗PVP/PKP骨水泥渗漏伴神经症状[J].中国矫形外科杂志,2020,28(2):182-185. [9] 乔俊,李松,李刚,等.单侧与双侧PVP治疗骨质疏松性椎体压缩骨折临床疗效比较及骨水泥渗漏的危险因素分析[J].现代生物医学进展,2023,23(14):2709-2713,2676. [10] 欧炳金,钱启恒,农宁,等.经皮椎体成形术治疗老年骨质疏松性椎体压缩骨折骨水泥渗漏的危险因素分析[J].骨科,2023,14(4):327-333. [11] 张桂川,尤连波,葛海,等.基于DR、CT及MRI多征象探讨经皮胸腰椎体成形术后骨水泥渗漏危险因素[J].中国CT和MRI杂志,2023,21(2):151-154. [12] 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.
2024, Vol. 30 
冀公网安备13080202000677号