[1]黄培楷,吴琴芙,刘海龙,等. 术前MRI对经皮椎体强化术中骨水泥渗漏风险的预测价值[J].中国医学物理学杂志,2018,35(12):1436-1440.[doi:DOI:10.3969/j.issn.1005-202X.2018.12.013]
　HUANG Peikai,WU Qinfu,LIU Hailong,et al. Predictive value of preoperative MRI for risk of bone cement leakage during percutaneous vertebral augmentation[J].Chinese Journal of Medical Physics,2018,35(12):1436-1440.[doi:DOI:10.3969/j.issn.1005-202X.2018.12.013]
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 术前MRI对经皮椎体强化术中骨水泥渗漏风险的预测价值()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
35卷
期数:
2018年第12期
页码:
1436-1440
栏目:
医学影像物理
出版日期:
2018-12-24

文章信息/Info

Title:
 Predictive value of preoperative MRI for risk of bone cement leakage during percutaneous vertebral augmentation
文章编号:
1005-202X（2018）12-1436-05
作者:
 黄培楷1; 吴琴芙2; 刘海龙1; 肖梦强1; 黄乐生1; 刘天柱1
 1.广东省中医院珠海医院影像科， 广东 珠海 519000； 2.广东省中医院珠海医院超声科， 广东 珠海 519000
Author(s):
 HUANG Peikai1;  WU Qinfu2;  LIU Hailong1;  XIAO Mengqiang1;  HUANG Lesheng1;  LIU Tianzhu1
 1. Department of Medical Imaging, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai 519000, China; 2. Department of Ultrasound, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai 519000, China
关键词:
 ; 经皮椎体强化术; 骨水泥; 渗漏风险; 磁共振成像; 预测价值
Keywords:
 ; Keywords: percutaneous vertebral augmentation;  bone cement;  risk of leakage;  magnetic resonance imaging;  predictive value
分类号:
R445.2；R683.2
DOI:
DOI:10.3969/j.issn.1005-202X.2018.12.013
文献标志码:
A
摘要:
 【摘 要】 目的：探讨术前磁共振成像（MRI）对经皮椎体强化术（PVA）中骨水泥渗漏风险的预测价值。 方法：选择广东省中医院珠海医院2016年5月~2018年5月收治的60例（共88个手术椎体）骨质疏松性椎体压缩性骨折患者，均行PVA术。术前行MRI检查，术后行DR进行复查。计算骨水泥渗漏发生率，比较临床因素［包括不同性别、不同年龄（≤70岁、＞70岁）、手术方式［经皮椎体后凸成形术（PKP）、经皮椎体成形术（PVP）］、椎体部位（胸椎、胸腰段、腰椎）、骨水泥注入量［（≤4 mL、＞4 mL）］及MRI征象（包括终板损伤、达终板骨折线、椎间盘损伤、椎体裂隙）对骨水泥渗漏发生率的影响。绘制受试者工作特征曲线分析MRI征象对骨水泥椎间盘渗漏的预测价值。 结果：性别、年龄、椎体部位及骨水泥注入量对骨水泥渗漏发生率的影响无统计学差异（P>0.05）；PKP的骨水泥渗漏发生率为26.67%（16/60），低于PVP的50%（14/28），差异有统计学意义（P<0.05）。术前MRI检查显示椎体终板损伤、椎体裂隙、椎间盘损伤、达终板骨折线的骨水泥渗漏发生率分别为27.40%、57.89%、30.30%、54.55%，高于无上述征象椎体的14.73%、27.54%、15.22%、27.27%，差异有统计学意义（P<0.05）。同时合并上述任意两种MRI征象、任意3种MRI征象、任意4种MRI征象患者的骨水泥渗漏发生率分别高达43.59%、56.00%、100%。同时合并任意两种MRI征象预测骨水泥渗漏的敏感度与特异度分别为0.818、0.553；同时合并任意3种MRI征象预测骨水泥渗漏的敏感度与特异度分别为0.727、0.763；同时合并4种MRI征象预测骨水泥渗漏的敏感度与特异度分别为0.727、1.000。 结论：PKP术后的骨水泥渗漏风险低于PVP，推荐骨质疏松性椎体压缩性骨折采取PKP术。另外，术前可行MRI检查，通过患者MRI征象对骨水泥渗漏风险进行预测。
Abstract:
 Abstract: Objective To explore the value of preoperative magnetic resonance imaging (MRI) to predict the risk of bone cement leakage in percutaneous vertebral augmentation (PVA). Methods A total of 60 patients (88 surgical vertebral bodies) with osteoporotic vertebral compression fractures admitted to Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine from May 2016 to May 2018 were treated with PVA. MRI was performed before operation and DR was performed after operation for reexamination. The rate of bone cement leakage was calculated. The influencing factors, including gender, age (≤70 years old, >70 years old), surgical methods ［percutaneous kyphoplasty (PKP), percutaneous vertebroplasty (PVP)］, vertebral body (thoracic vertebrae, thoracolumbar vertebrae, lumbar vertebrae), volume of bone cement injection ［(≤4 mL, >4 mL)］ and MRI signs (endplate damage, endplate fracture line, intervertebral disc injury, vertebral body fissure) were compared. The receiver operating characteristic curve (ROC) was used to analyze the predictive value of MRI signs for cement intervertebral disc leakage. Results The effects of gender, age, vertebral body and volume of bone cement injection on the rate of bone cement leakage were marginal, without statistical differences (P>0.05). The rate of bone cement leakage was 26.67% (16/60) in patients treated with PKP, lower than 50% (14/28) in patients receiving PVP, and the differences were statistical (P<0.05). Preoperative MRI examination showed that the incidences of bone cement leakage in vertebral body with MRI signs of vertebral endplate injury, vertebral fissure, disc injury, and endplate fracture line were 27.40%, 57.89%, 30.30% and 54.55%, respectively, which were higher than 14.73%, 27.54%, 15.22%, 27.27% in the vertebral body without the above signs, and the difference was statistically significant (P<0.05). The incidences of bone cement leakage in patients with any 2, 3 and 4 kinds of the above MRI signs were up to 43.59%, 56.00% and 100.00%, respectively. The sensitivity of combining any 2, 3 and 4 kinds of the MRI signs to predict bone cement leakage was 0.818, 0.727 and 0.727, respectively, and the specificity was 0.553, 0.763 and 1.000, respectively. Conclusion PKP, with a lower risk of bone cement leakage than PVP, is recommended for osteoporotic vertebral compression fractures. In addition, preoperative MRI can be used to predict the risk of bone cement leakage through MRI signs.

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备注/Memo

备注/Memo:
 【收稿日期】2018-07-15
【基金项目】珠海市卫生科技计划项目（20161027E030001）
【作者简介】黄培楷，主治医师，主要从事医学影像诊断，E-mail: 6251758@163.com
【通信作者】吴琴芙，主治医师，主要从事超声诊断，E-mail: wqfgrace@163.com
更新日期/Last Update: 2018-12-26