PKP并发骨水泥渗漏的影像学观察及临床分型

目的 影像学观察及临床分析经皮椎体后凸成形术(percutaneous kyphoplasty, PKP)治疗骨质疏松性椎体压缩性骨折并发的骨水泥渗漏。方法 回顾性分析2011年2月至2013年10月138例(共177椎体)行PKP治疗的骨质疏松性胸腰椎骨折患者的临床数据资料,术后CT影像学中椎体外骨水泥渗漏的解剖位置分5型: 椎旁渗漏型、椎间盘渗漏型、椎管渗漏型、椎弓根渗漏型,混合渗漏型(包含两种或两种以上渗漏),评估骨水泥渗漏与终板破坏的相关性。结果 术前CT提示125椎发生终板破坏,发生率70.6%,术后CT发现81椎出现骨水泥渗漏,渗漏发生率为45.8%,29椎为椎旁渗漏型,17椎为椎间盘渗漏型,12椎为椎管渗漏型,9椎为椎弓根渗漏型,14椎为混合型渗漏型。伤椎终板破坏与椎间盘渗漏密切相关。结论 经皮椎体成形术后并发骨水泥渗漏发生率较高,以椎旁渗漏最为多见,其次为椎间盘渗漏和椎管渗漏,伤椎终板破坏与椎间盘渗漏明显相关。

Radiologic observation and clinical analysis for cement leakage after percutaneous kyphoplasty

Objective To observe and analyze for cement leakage after percutaneous kyphoplasty(PKP) in patients with osteoporotic vertebral compression fracture. Methods One hundred and thirty eight patients (177 vertebrae) with osteoporotic vertebral compression fracture were treated with PKP from February 2011 to October 2013. Computed tomography (CT) scan was performed to determine the end-plate defects before operation and analyze the cement leakage after operation. The patterns of cement leakage were classified as five types: through a cortical defect or para-vertebral vein into the para-spinal tissues; via the needle channel; through a cortical defect into the disc space; leak into spinal canal and mixed cement leakage (including two or more types). The relationship between disc type with end-plate defect was analyzed. Results All patients underwent preoperative and postoperative CT scan, end-plate defects were detected in 125 vertebral bodies (70.6%) before operation and cement leakage was detected in 81 vertebral bodies (45.8%) after operation, including 29 of para-vertebral type, 17 of disc type, 12 of spinal canal type, 9 of pedicle type and 14 of mixed type. End-plate defects were significantly correlated with leakage of disc space. Conclusion High incidence of cement leakage occurs in PKP treatment; para-vertebral type is the most common one, followed by leakage of disc space and spinal canal; end-plate defects are associated with leakage of disc space.