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Correlative Factor Analysis on the Complications Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures

Author: RenHu
Tutor: ShenYong
School: Hebei Medical University
Course: Surgery
Keywords: Percutaneous vertebroplasty kyphoplasty Osteoporosis Vertebral compression fractures Complication Relevant factors
CLC: R687.3
Type: Master's thesis
Year: 2010
Downloads: 86
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Abstract

Objective: In recent years, percutaneous vertebral kyphoplasty (percutaneous kyphoplasty, PKP) has been widely used, this type of surgery is not only good to ease the patient's pain, but also be able to compression fractures of vertebral reset to a certain height, which can be corrected kyphosis. A large number of reported significant efficacy of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures. Many studies have reported complications caused due to the leakage of bone cement Although most complications are caused by neurological symptoms, but once the bone cement leakage into the spinal canal or nerve root canal can cause neurological symptoms, serious need again surgery. In addition, cement leakage into the disc increases the risk of vertebral body and then fracture occurs near the stage. Due to the above reasons, how to reduce the leakage of bone cement has become the problems faced by the PKP surgery, have not been reported in the current literature related factors on the impact of of PKP surgical complications, retrospective analysis of a group of PKP surgery, and then analyzes the impact of PKP concurrent The clinical application of the relevant factors of the disease, in order to better guide the PKP surgery. Methods: 71 cases in our hospital PKP surgery patients with a total of 171 vertebral analyzed retrospectively. The compression height of the vertebral body, the local Cobb angle, VAS of ratings and Oswesty function score changes to evaluate the surgical efficacy by observing patients before and after surgery. According to the preoperative CT to determine the integrity of the vertebral peripheral wall. According to the MRI signal changes in the vertebral divided into two types, namely fresh type: T1WI on T2WI signal in the vertebral body uniform distribution of low signal in T1WI, T2WI and STIR sequences showed high signal, and the gradual transition of normal bone marrow The border was unclear. The uneven distribution of the Asian fresh: T1WI and T2WI signal in the vertebral body, patchy, punctate or strip distribution. Signal change is not uniform, the performance of low signal for the T1WI, etc., mixed, T2WI and STIR sequences, low, high variety of signal mixed. Scale lateral radiographs were measured before and after surgery vertebral and central height and Cobb angle and vertebral and mid-height of the average calculated before and after surgery as each vertebral spine lateral X-ray films before and after surgery, the average height of the column before the body. Cobb angle measurements using the method of Phillips, according to the preoperative and postoperative conventional shooting to vertebral centric standard lateral X-ray measurements from a vertebral body on vertebral endplate vertebral vertebral body of the inferior endplate Cobb angle is defined as \For multiple vertebral compression fractures, vertebral connected measuring a common local sagittal Cobb angle, vertebral connected local sagittal Cobb angle were measured. Local sagittal Cobb angle changes can reflect each vertebral height restoration of the situation and the degree of kyphosis correction. All the measurements taken by two spine surgeons not involved in the surgery alone completed, two doctors take the average as the final results of the analysis between the measurement results. Cement leakage into leakage group and non-leakage occurred according to the patient and, respectively, between the two groups preoperative vertebral column average height, preoperative Cobb angle, the amount of bone cement injected into fractures freshness, The approach by unilateral and bilateral pedicle vertebral operating parts and whether vertebral peripheral wall destroyed difference, which determine the relevant factors that affect the PKP surgical bone cement leakage. Results: after PKP, all patients with pain symptoms quickly and effectively alleviate. A total of 17 vertebral cement leakage, leakage rate of 9.94%, of which 7 cases, 6 cases of intervertebral space leakage to paravertebral leakage, three cases of extravasation along the pedicle needle pathway, a small amount of seepage one cases of spinal leakage; 4 cases (5.63%) had lung-related complications, including one case diagnosed with bone cement pulmonary embolism; 6 cases (8.45%) 9 vertebral fracture again six adjacent vertebral bodies. Univariate analysis showed that the degree of vertebral compression, the amount of bone cement injected, and the presence of vertebral week between the the leakage group with the non-leakage group of patients in the wall between the destruction aspects of a statistically significant difference (P lt; 0.05), while the two The difference between the group of patients with preoperative Cobb angle fracture freshness, vertebral operating parts and surgical approach pathway without statistical significance (P gt; 0.05). Multivariate analysis results showed that the amount of bone cement injected (P lt; 0.01, OR = 3.105,95% CI = 1.674-5.759), and the presence of vertebral peripheral wall damage (P lt; 0.01, OR = 11.960,95% CI = 3.512- 40.729) is the main factors to affect the PKP surgical bone cement leakage. The past history of preoperative lung disease patients are more prone to lung-related complications. Conclusion: Percutaneous vertebroplasty kyphosis angioplasty is an effective method for the treatment of osteoporotic vertebral compression fractures. But often occurs during surgery extravasation of the bone cement. Bone cement injection dose, bone cement viscosity, and vertebral week wall with or without destruction influence the PKP surgical bone cement extravasation risk factors, past history of lung disease patients are more prone to lung-related complications. Therefore, the in percutaneous kyphoplasty process must these factors cause a high degree of attention to the improvement of the surgical technique is the key to preventing complications.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Bone surgery
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