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Abstract Objective To explore the efficacy of percutaneous kyphoplasty(PKP) for the treatment of osteoporotic vertebral compression fractures(OVCF) and the related factors of bone cement leakage situation，and to optimize the surgical protocol.Methods We retrospectively reviewed 56 patients treated with PKP due to spinal fracture from 2019 to 2020，and the patients included 10 males and 46 females.The age ranged from 51 to 87 years，with an average of (69.60±8.85)years.The distribution of fractured vertebrae was as follows：4 cases of 3 vertebrae，4 cases of 2 vertebrae，and 48 cases of single vertebra.2 T8，2 T9，4 T10，14 T11，5 T12，14 L1，6 L2，9 L3，8 L4，and 4 L5 vertebrae.X-ray，CT，MRI，and BMD were performed on all patients before the operation. Postoperative review of imaging data，assessment of treatment effect，statistics on bone cement leakage cases.The effect of the surgery was analyzed by paired t-test，logistic regression analysis，and linear regression analysis to explore the cause and optimize the surgical protocol.Results All the operations were performed successfully.The compressed vertebral height and Cobb angle of the injured vertebrae were recovered in patients after surgery compared with those before surgery.There were 36 vertebrae with cement leakage.We found that the surgical effect of PKP was related to the amount of cement injected，the degree of disc degeneration，age，the degree of vertebral compression，and the volume of the balloon(D-W≈2，VIF＜5，P＜0.05).Risk factors for cement disc leakage included more cement injection，superior endplate fracture，and cement in the vertebral close to the Superior endplate(Hosmer Lemeshow test=0.780，P＜0.05).Conclusion PKP needs to refine preoperative imaging studies to develop a surgical protocol based on the degree of disc degeneration，age，and degree of vertebral compression.The amount of cement injection，the volume of the balloon，and the distribution pattern of cement can be controlled intraoperatively to obtain a better surgical result and to reduce surgical complications.
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