目的:肺栓塞,心脏栓塞,甚至由于椎旁静脉渗漏(PVL)引起的脑栓塞也越来越多地被报道,他们的危险因素需要充分调查以进行预防。为此,本研究探讨了经皮椎体成形术(PVP)后骨折线的分布和形态特征与PVL发生的相关性,以前没有报道过。
方法:选择2019年1月至2022年7月在我院接受PVP治疗的急性单节段胸腰椎骨质疏松性椎体压缩骨折(OVCFs)患者进行配对病例对照研究。病例组和对照组包括有和没有PVL的患者,分别,根据一般临床特征以1:1的比例匹配。此外,两组均进行骨折图和热图分析.除了一般的临床特征,椎体高度比,穿刺角度,交货率,并通过三维CT重建骨折线标测技术对指标进行评估,即,断裂线的分布,断裂线长度,主断裂线形状,骨折线受累的位置,和断裂线分支的数量,对两组进行比较。Wilcoxon秩和检验,t测试,方差分析,采用条件logistic回归进行统计分析。
结果:在658例OVCF患者中,本研究包括54名患者和54名未发生PVL的患者。穿刺角度的显著差异,断裂线分布(MR-1,ML-2,MM-2,MR-2,ML-3,MM-3,LL-1,LM-1,LL-2,LM-2),后壁骨折线受累,断裂线总长度,两组间的骨折线长度比较差异有统计学意义(p<0.05)。Logistic单因素分析显示穿刺角度存在显著差异,断裂线分布(MR-1,ML-2,MM-2,MR-2,ML-3,MM-3,LL-1,LL-2,LM-2,LL-3),断裂线总长度,主断裂线长度,和骨折线累及后壁(p<0.05)。Logistic多因素分析显示,骨折线分布(UR-3、ML-3、LM-2、LR-2)和主要骨折线长度是两组发生PVL的独立危险因素。此外,骨折图和热图显示,与对照组相比,PVL组的骨折线包裹度更高,椎体中下部受累更广泛.
结论:通过基于三维计算机断层扫描重建的骨折线测绘技术,这项研究首次揭示了骨折线分布(UR-3、ML-3、LM-2、LR-2)和主要骨折线长度是急性单节段胸腰椎OVCFs患者PVP术后PVL的独立危险因素。此外,我们假设急性OVCF患者伤后2周内可能出现的骨折线静脉交通分支可能是影响上述与PVL相关的潜在独立危险因素的机制之一.
OBJECTIVE: Pulmonary embolism, cardiac embolism, and even cerebral embolism due to paraspinal vein leakage (PVL) are increasingly reported, and their risk factors need to be adequately investigated for prevention. To this end, this study investigated the correlation of the distribution and morphological characteristics of fracture lines with the occurrence of PVL after percutaneous vertebroplasty (PVP), which has not been previously reported.
METHODS: Patients with acute single-segment thoracolumbar osteoporotic vertebral compression fractures (OVCFs) treated with PVP at our institution from January 2019 to July 2022 were selected for a matched
case-control study. The
case and control groups included those with and without PVL, respectively, matched at a 1:1 ratio based on general clinical characteristics. Additionally, fracture map and heatmap analysis was performed in both groups. In addition to the general clinical characteristics, the vertebral height ratio, puncture angle, delivery rate, and indexes were assessed via the three-dimensional CT reconstruction fracture line mapping technique, namely, the distribution of fracture lines, fracture line length, main fracture line shape, location of fracture line involvement, and number of fracture line branches, were compared between the two groups. The Wilcoxon rank-sum test, t tests, analysis of variance, and conditional logistic regression were used for statistical analysis.
RESULTS: Among 658 patients with OVCFs, 54 who did and 54 who did not develop PVL were included in this study. Significant differences in the puncture angle, fracture line distribution (MR-1, ML-2, MM-2, MR-2, ML-3, MM-3, LL-1, LM-1, LL-2, LM-2), fracture line involvement of the posterior wall, total fracture line length, and main fracture line length were found between the two groups (p < 0.05). Logistic univariate analysis showed significant differences in the puncture angle, fracture line distribution (MR-1, ML-2, MM-2, MR-2, ML-3, MM-3, LL-1, LL-2, LM-2, LL-3), total fracture line length, main fracture line length, and fracture line involvement of the posterior wall between the two groups (p < 0.05). Logistic multifactorial analysis showed that the fracture line distribution (UR-3, ML-3, LM-2, LR-2) and main fracture line length were independent risk factors for the development of PVL in both groups. In addition, the fracture maps and heatmaps showed a greater degree of fracture line encapsulation and more extensive involvement in the middle and lower regions of the vertebral body in the PVL group than in the control group.
CONCLUSIONS: Through a three-dimensional computed tomography reconstruction-based fracture line mapping technique, this study revealed for the first time that the distribution of fracture lines (UR-3, ML-3, LM-2, LR-2) and main fracture line length were independent risk factors for PVL after PVP in patients with acute single-segment thoracolumbar OVCFs. In addition, we hypothesized that the fracture line-vein traffic branch that may appear within 2 weeks after injury in acute OVCF patients may be one of the mechanisms influencing the above potential independent risk factors associated with PVL.