Analysis of Potential Risk Factors for Cement Leakage into Paraspinal Veins after Vertebroplasty for Acute Osteoporotic Vertebral Fractures Based on a 3D Reconstruction Technique: A Retrospective Matched Case–Control Study
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 morphologi...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-12-01
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| Series: | Orthopaedic Surgery |
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| Online Access: | https://doi.org/10.1111/os.13924 |
| _version_ | 1827596567921557504 |
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| author | Fan Yang Zhengang Liu Pengfu Li Qingsan Zhu Qinwan He Yuling Liang Boyin Zhang |
| author_facet | Fan Yang Zhengang Liu Pengfu Li Qingsan Zhu Qinwan He Yuling Liang Boyin Zhang |
| author_sort | Fan Yang |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-09T03:12:23Z |
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| language | English |
| last_indexed | 2024-03-09T03:12:23Z |
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| series | Orthopaedic Surgery |
| spelling | doaj.art-e86f83f4f0a7494e835fb163834b39f22023-12-04T02:35:48ZengWileyOrthopaedic Surgery1757-78531757-78612023-12-0115123209322210.1111/os.13924Analysis of Potential Risk Factors for Cement Leakage into Paraspinal Veins after Vertebroplasty for Acute Osteoporotic Vertebral Fractures Based on a 3D Reconstruction Technique: A Retrospective Matched Case–Control StudyFan Yang0Zhengang Liu1Pengfu Li2Qingsan Zhu3Qinwan He4Yuling Liang5Boyin Zhang6Department of Orthopaedics China‐Japan Union Hospital of Jilin University Changchun ChinaDepartment of Orthopaedics China‐Japan Union Hospital of Jilin University Changchun ChinaDepartment of Orthopaedics China‐Japan Union Hospital of Jilin University Changchun ChinaDepartment of Orthopaedics China‐Japan Union Hospital of Jilin University Changchun ChinaJilin University Changchun ChinaJilin University Changchun ChinaDepartment of Orthopaedics China‐Japan Union Hospital of Jilin University Changchun ChinaObjective 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.https://doi.org/10.1111/os.139243D reconstruction techniquefracture line‐vein traffic branchosteoporotic vertebral compression fracturesparaspinal vein leakagepercutaneous vertebroplasty |
| spellingShingle | Fan Yang Zhengang Liu Pengfu Li Qingsan Zhu Qinwan He Yuling Liang Boyin Zhang Analysis of Potential Risk Factors for Cement Leakage into Paraspinal Veins after Vertebroplasty for Acute Osteoporotic Vertebral Fractures Based on a 3D Reconstruction Technique: A Retrospective Matched Case–Control Study Orthopaedic Surgery 3D reconstruction technique fracture line‐vein traffic branch osteoporotic vertebral compression fractures paraspinal vein leakage percutaneous vertebroplasty |
| title | Analysis of Potential Risk Factors for Cement Leakage into Paraspinal Veins after Vertebroplasty for Acute Osteoporotic Vertebral Fractures Based on a 3D Reconstruction Technique: A Retrospective Matched Case–Control Study |
| title_full | Analysis of Potential Risk Factors for Cement Leakage into Paraspinal Veins after Vertebroplasty for Acute Osteoporotic Vertebral Fractures Based on a 3D Reconstruction Technique: A Retrospective Matched Case–Control Study |
| title_fullStr | Analysis of Potential Risk Factors for Cement Leakage into Paraspinal Veins after Vertebroplasty for Acute Osteoporotic Vertebral Fractures Based on a 3D Reconstruction Technique: A Retrospective Matched Case–Control Study |
| title_full_unstemmed | Analysis of Potential Risk Factors for Cement Leakage into Paraspinal Veins after Vertebroplasty for Acute Osteoporotic Vertebral Fractures Based on a 3D Reconstruction Technique: A Retrospective Matched Case–Control Study |
| title_short | Analysis of Potential Risk Factors for Cement Leakage into Paraspinal Veins after Vertebroplasty for Acute Osteoporotic Vertebral Fractures Based on a 3D Reconstruction Technique: A Retrospective Matched Case–Control Study |
| title_sort | analysis of potential risk factors for cement leakage into paraspinal veins after vertebroplasty for acute osteoporotic vertebral fractures based on a 3d reconstruction technique a retrospective matched case control study |
| topic | 3D reconstruction technique fracture line‐vein traffic branch osteoporotic vertebral compression fractures paraspinal vein leakage percutaneous vertebroplasty |
| url | https://doi.org/10.1111/os.13924 |
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