经皮椎体强化术中骨水泥漏的多因素分析

目的探讨经皮椎体强化术中骨水泥漏的危险因素,为临床预防骨水泥漏的发生提供依据。方法回顾2010年1月—2014年6月我科收治的431例（667节段椎体）行椎体强化术患者的病史资料,以是否并发骨水泥漏将患者分为两组,记录患者的年龄、性别、体重指数（body mass index,BMI）、疾病种类、手术方式、手术节数、手术节段、骨水泥注入量及手术医师资历。将上述可能与并发骨水泥漏相关的因素先行单因素分析,筛选出有统计学差异的因素再行多因素Logistic回归,分析其与椎体强化骨水泥漏的关系。结果 431例（667节段椎体）患者中78例（109节段椎体）发骨水泥漏,发生率为16.34%（109/667）,椎体成形术漏的发生率为23.8%（81/260）,椎体后凸成形术为8.58%（28/298）。骨水泥漏相关因素单因素分析,采用卡方检验,结果显示骨水泥漏与不漏两组病例年龄、性别、体重指数、医师资历方面差异无统计学意义（P〉0.05）;疾病类型、手术方式、手术节段数、手术节段、骨水泥量差异方面有统计学意义（P〈0.05）;多因素Logistic回归分析显示,手术方式（OR=3.393,95%CI=1.416-8.138）、疾病类型（OR=1.621,95%CI=1.084-2.424）、手术节段数（OR=2.388,95%CI=1.043-5.465）、骨水泥量（OR=2.162,95%CI=1.024-4.565）是骨水泥漏的危险因素（OR〉1）。结论疾病类型、手术方式、手术节段数、骨水泥量对椎体强化术中骨水泥漏有重要影响。

Multivariate analysis of risk factors for extravertebral cement leakage complicated by percutaneous vertebral augmentation

Objective To explore the risk factors for extravertebral cement leakage following percutaneous vertebral augmentaion PVA）, in addition,to provide references for preventionand manage-ments. Methods A total of 431 patiens（667 vertebrals） who had received percutaneous vertebral augmentation from January 2010 to june 2014 in our department were enrolled. According to leakage or no leakage, the patients were divided into two groups.Data of age,gender,body mass index（BMI）,diseases, surgical mode,mumber of surgical levels, suigical position, cement volume and operator﹐s qualifications. Univariate analysis was firstly used to explore significant factors for cement leakage,and then these factors were measured by multivariate logistic analysis to identify the risk factors for cement leakage following PVA. Results In all 431 cases（667vertebrals）,78 cases（109 vertebral） suffered cement leakage, the incidence rate was 16.34%（109/667）.And incidence rate was 23.8%（81/260） in PVP,8.58%（28/298） in PKP.Univariate analysis showed statistical differences in diseases, surgical mode,mumber of surgical levels, suigical position and cement volume（P〈0.05）. Multivariate Logistic analysis showed the diseases（OR=1.621,95% CI=1.084-2.424） 、surgical mode（OR=3.393, 95%CI=1.416-8.138）、suigical position（OR=2.388,95%CI=1.043-5.465） and cement volume（OR=2.162, 95%CI=1.024-4.565） were risk factors for cementleakage（OR 〉1）.Conclusion The disease、surgical mode、suigical position and cement volume seriously affect the incidence of cement leakage follow- ing PVA.