Related Factors Analysis Of The Bone Cement Leakage In Percutaneous Kyphoplasty

Objective:To analyze the related factors of bone cement leakage after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fractures and predict the cement leakage through preoperative factors.Aim to modify the surgical techniques to reduce the occurrence of cement leakage.Methods:A data of 298 patients(400 vertebrae)underwent single and multiple segments kyphoplasty for osteoporotic vertebral compression fractures from January 2016 to December 2017 in our hospital were analyzed retrospectively.Images and clinical data were collected of these patients.Age,gender,the distribution of fracture line,injected cement volume,Kummell disease,fracture segment and expansion method were included in the statistical analysis.Binary logistic regression analysis was utilized to explore the correlation of these factors and the bone cement leakage.Basing on the distribution of the fracture lines,the vertebrae were divided into N type(none of fracture line,8.3%),A type(in anterior wall vertebra,25.8%),E type(in superior and/or inferior endplate(s),10%),H type(both in anterior wall and superior and/or inferior endplate(s),56%),according to the preoperative CT.Cement leakage was assessed using images and classified into 4 different types with different potential positions:T-type(in paravertebral tissue),V-type(in paravertebral vein),C-type(in spinal canal),D-type(in intervertebral disc).Multivariate logistic regression was used to explore the correlation between various types of cement leakage and these independent factors.Results:The cement leakage was detected in 303 of 400 vertebrae(75.8%)and was not founded in 97 vertebrae(24.2%).The most common types of leakage detected was T-type(250 vertebrae,62.5%),the other types were as follows,D-type(87 vertebrae,21.8%),V type(69 vertebrae,17.3%),C type(30 vertebrae,7.5%).the distribution of injected cement volume,Kummell disease,the distribution of fracture line and expander were the potential factors of cement leakage(P<0.05,respectively)by binary logistic regression analysis.Injected cement volume(OR=1.123),the distribution of fracture line were assessed the risk factors for cement leakage.Presence of Kummell disease(OR=0.283)and expander(OR=0.156)were identified the protective factors.Multivariate Logistic regression analysis showed that the related factors of T-type were age,presence of Kummell disease,type A,type H and expander expansion,age(OR=0.969),Kummell disease(OR=0.179)and expander expansion(OR=0.135)as a protective factor,A type(OR=121.524)and H type(OR=60.387)were risk factors;the risk factors of V-type of thoracic vertebral compression fracture(OR=2.407)and A type(OR=9.116);Kummell disease(OR=4.952)was the risk factor of C-type;related factors of D-type were age,E type and H type.Age(OR=0.970)was the protective factor,E type(OR=18.879)and H type(OR=6.478)were the risk factors.Conclusion:The volume of injected cement,Kummell disease,the distribution type of fracture line and expansion method both were the significant related factors for cement leakage.The distribution of fracture lines is an important factor affecting the multi-type of cement leakage.On the basis of the good cement pattern,using the less injected cement volume,establishing the individualized expansion and injection method according to the distribution of fracture lines were essential to reduce all types of cement leakage.