水泥增强椎弓根螺钉内固定中水泥渗漏的危险因素:一项140例患者和650枚螺钉的多中心研究。

IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY
Shota Tamagawa, Hidetoshi Nojiri, Hiromitsu Takano, Akira Itoi, Ryosuke Yokota, Takao Shiobara, Kentaro Ishii, Taishi Takeuchi, Tomoya Kojo, Yuya Ishii, Arihisa Shimura, Juri Teramoto, Hisashi Ishibashi, Yuta Sugawara, Kazuki Nakai, Yukoh Ohara, Takeshi Hara, Eiji Abe, Takatoshi Okuda, Ryosuke Takahashi, Yutaka Kono, Yoshio Sakuma, Shigemasa Takamiya, Muneaki Ishijima
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CL was assessed by postoperative CT and classified as type S (segmental vein), type B (basivertebral vein), or type I (malpositioned screws). Multivariate logistic regression was performed to identify independent risk factors for intravenous CL.ResultsCL was observed in 88/140 patients (62.9%) and 190/650 screws (29.2%). Type S leakage was most common (77.9%), followed by type B (11.6%) and type I (7.9%). No symptomatic pulmonary cement embolism occurred; however, 1 patient experienced CL-related nerve root injury. Lower femoral neck T-score (aOR: 0.61; <i>P</i> = 0.009) was an independent risk factor for intravenous CL, while diffuse idiopathic skeletal hyperostosis was protective (aOR: 0.24; <i>P</i> = 0.009). Type S leakage was associated with shorter distance from the cement hole to the vertebral sidewall (aOR: 0.77; <i>P</i> < 0.001) and smaller vertebral body cross-sectional area (aOR: 0.87; <i>P</i> = 0.030). 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引用次数: 0

摘要

研究设计:多中心回顾性队列研究。目的:骨水泥增强椎弓根螺钉(CAPS)可增强骨质疏松患者的固定,但存在骨水泥渗漏(CL)的风险,可能导致肺栓塞和神经功能障碍。本研究旨在探讨CL的发病率、分型及危险因素。方法我们纳入了7家机构的140例接受cap胸椎或腰椎融合的患者。术后CT评估CL,分为S型(节段静脉)、B型(椎基静脉)和I型(螺钉错位)。多因素logistic回归分析确定静脉CL的独立危险因素。结果140例患者中有88例(62.9%)出现scl, 190例/650例螺钉中有29.2%出现scl。S型渗漏最常见(77.9%),其次是B型(11.6%)和I型(7.9%)。无肺水泥栓塞症状;1例患者出现cl相关性神经根损伤。股骨颈下段t评分(aOR: 0.61;P = 0.009)是静脉CL的独立危险因素,而弥漫性特发性骨骼增生是保护性因素(aOR: 0.24;P = 0.009)。S型渗漏与水泥孔到椎体侧壁的距离较短有关(aOR: 0.77;P < 0.001)和较小的椎体截面积(aOR: 0.87;P = 0.030)。B型渗漏与椎体后壁距离较短有关(aOR: 0.71;P < 0.001)和下蒂Hounsfield单位(aOR: 0.99;P = 0.041)。结论cap固定后常出现有症状的CL。术前影像学评估和精确的螺钉置入可降低CL风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Risk Factors for Cement Leakage in Cement-Augmented Pedicle Screw Fixation: A Multicenter Study of 140 Patients and 650 Screws.

Study DesignMulticenter retrospective cohort study.ObjectivesCement-augmented pedicle screws (CAPS) enhance fixation in osteoporotic patients, but carry a risk of cement leakage (CL), potentially leading to pulmonary embolism and neurological deficits. This study aimed to investigate the incidence and classification of CL and identify risk factor.MethodsWe included 140 patients undergoing thoracic or lumbar spinal fusion with CAPS at 7 institutions. CL was assessed by postoperative CT and classified as type S (segmental vein), type B (basivertebral vein), or type I (malpositioned screws). Multivariate logistic regression was performed to identify independent risk factors for intravenous CL.ResultsCL was observed in 88/140 patients (62.9%) and 190/650 screws (29.2%). Type S leakage was most common (77.9%), followed by type B (11.6%) and type I (7.9%). No symptomatic pulmonary cement embolism occurred; however, 1 patient experienced CL-related nerve root injury. Lower femoral neck T-score (aOR: 0.61; P = 0.009) was an independent risk factor for intravenous CL, while diffuse idiopathic skeletal hyperostosis was protective (aOR: 0.24; P = 0.009). Type S leakage was associated with shorter distance from the cement hole to the vertebral sidewall (aOR: 0.77; P < 0.001) and smaller vertebral body cross-sectional area (aOR: 0.87; P = 0.030). Type B leakage was associated with shorter distance to the vertebral posterior wall (aOR: 0.71; P < 0.001) and lower pedicle Hounsfield units (aOR: 0.99; P = 0.041).ConclusionsAsymptomatic CL was frequently observed following CAPS fixation. Preoperative imaging assessments and precise screw placement may reduce the CL risk.

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来源期刊
Global Spine Journal
Global Spine Journal Medicine-Surgery
CiteScore
6.20
自引率
8.30%
发文量
278
审稿时长
8 weeks
期刊介绍: Global Spine Journal (GSJ) is the official scientific publication of AOSpine. A peer-reviewed, open access journal, devoted to the study and treatment of spinal disorders, including diagnosis, operative and non-operative treatment options, surgical techniques, and emerging research and clinical developments.GSJ is indexed in PubMedCentral, SCOPUS, and Emerging Sources Citation Index (ESCI).
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