| Purpose:A fracture line mapping system was introduced to spine surgeons through 3D CT reconstruction to investigate the correlation between fracture line distribution and morphological characteristics within the vertebral body and paravertebral vein leakage(PVL)of bone cement in patients with osteoporotic compression fractures(OVCF)of the thoracolumbar segment.Background:Vein leakage of bone cement is the most common leakage route after percutaneous vertebraplasty(PVP),and paravertebral vein leakage has a certain chance of causing severe organ embolism.Previous studies at home and abroad have explored the correlation of venous anatomic factors,demographic differences,imaging factors,and iatrogenic factors in bone cement paravertebral vein leakage,but no reports have explored the relationship between fracture line distribution and morphological characteristics.Methods:658 patients with OVCF in the thoracolumbar segment treated with PVP from January 2019 to July 2022 were reviewed,and 312 patients were initially excluded based on inclusion and exclusion criteria.They were divided into two groups based on imaging assessment:group A for the occurrence of PVL and group B for the absence of bone cement leakage.After evaluation,54 patients in group A were included,and 54 patients in group B were randomly matched 1:1(Random number table method).There were no significant differences between the two groups in terms of age,sex,body mass index(BMI),bone mineral density(BMD),fracture time,cement injection volume and fracture segment(P>0.05).Based on the 3D reconstruction technique,the distribution of fracture lines,major fracture line shapes,fracture line involvement locations,fracture line lengths,fracture line branches and number of branches were measured,fracture maps and heat maps of the two groups were drawn,and the differences in quantitative indexes between the two groups were compared and fracture map and heat map analyses were performed.LASSO and logistic regression analysis were used to screen independent risk factors,and Nomogram prediction models were constructed and given validation.In addition,the differences in fracture line distribution between the two groups were analyzed descriptively based on the fracture map results.Results:(1)The results of univariate analysis showed that the fracture lines were distributed in MR-1,ML-1,MM-2,MR-2,ML-1,MM-3,LL-1,LM-1,LL-1,L-2,LM2,LM-2,LL-1,the fracture line involved the posterior wall,the total length of the fracture line,and the length of the main line of the fracture line were correlated with the occurrence of PVL(p<0.05).There were no significant differences in fracture line shape,fracture line branches and number of branches between the two groups(p>0.05).(2)The results of LASSO and logistic regression analysis showed that the fracture line distributed in the MM-2 region and the fracture line involved the posterior wall of the vertebral body were independent risk factors(p<0.05).When the fracture line was located in the MM-2 region,the risk of PVL was 3.514-fold higher(95%CI:1.4138.74).When the fracture line involved the posterior wall,the risk of PVL was 6.303fold higher(95%CI:1.255-31.653).(3)The Nomogram model showed that the incidence of PVL was about 26%when the fracture line was located in the MM-2 region.When the fracture line involved the posterior wall,the incidence of PVL was about 38.5%.The incidence of PVL was about 70%when the above two conditions occurred simultaneously.(4)The results of Nomogram showed that the corrected curve basically coexisted with the ideal curve,and the AUC of the prediction model,rear wall and MM2 were 0.74(0.647--0.82),0.648(0.55--0.738),and 0.704(0.608--0.788),respectively.The decision curve shows that when the threshold probability is between 31%and 89%,it has a higher net benefit value.(5)There were 122 fracture lines in group A(A-T:58;A-L:64)and B group had 119 fracture lines(B-T:51;B-L:68);Fracture map and fracture heat map analysis showed that the fracture lines in both groups presented A coiled distribution,but the fracture lines in group A were more extensive and more continuous than those in group B.The difference in fracture line distribution between the two groups was more obvious in the middle and lower regions of the vertebral body,especially in the middle region.Conclusion:(1)After PVP treatment of single-level thoracolumbar OVCF,"Fracture line distribution in MR-1,ML-1,MM-2,MR-2,ML-1,MM-3,LL-1,LM-1,LL-2,LM2,LM-2,LM-3,LL-1,LM-2,LM-2,LL-1,LM-2,LL-3","fracture line involvement in the posterior wall","total fracture line length and excessive length of fracture line main line" are potential influencing factors for the occurrence of PVL,among which,The location of the fracture line in the MM-2 region or the involvement of the fracture line with the posterior wall are independent risk factors for the occurrence of PVL,suggesting that the occurrence of these two features should be more alert to the occurrence of PVL.(2)Fracture map and heat map analysis showed that the distribution of fracture lines had a certain influence on the occurrence of PVL,especially when the fracture lines were distributed in the middle and lower regions,PVL might be more likely to occur.(3)Based on the results of this study,the potential mechanism of"fracture line-vein traffic branch" was proposed for the first time,and a possible theoretical support was also given.(4)The fracture line mapping system based on 3D CT reconstruction is essential to avoid the occurrence of PVL,and the puncture recommendations proposed in this study should be taken into account to guide the appropriate puncture strategy based on the distribution and characteristics of the fracture line.(5)In studying the association between fracture line distribution and characteristics and PVL,this paper emphasizes the importance of the 3D CT reconstruction fracture line mapping system for spine surgery,which is a new perspective that should be emphasized. |
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