骨质疏松性骨折与慢性脊髓损伤患者的住院风险。
Osteoporotic fractures and hospitalization risk in chronic spinal cord injury.
机构信息
Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, MA 02118, USA.
出版信息
Osteoporos Int. 2009 Mar;20(3):385-92. doi: 10.1007/s00198-008-0671-6. Epub 2008 Jun 26.
UNLABELLED
Osteoporosis is a well acknowledged complication of spinal cord injury. We report that motor complete spinal cord injury and post-injury alcohol consumption are risk factors for hospitalization for fracture treatment. The clinical assessment did not include osteoporosis diagnosis and treatment considerations, indicating a need for improved clinical protocols.
INTRODUCTION
Treatment of osteoporotic long bone fractures often results in lengthy hospitalizations for individuals with spinal cord injury. Clinical features and factors that contribute to hospitalization risk have not previously been described.
METHODS
Three hundred and fifteen veterans > or = 1 year after spinal cord injury completed a health questionnaire and underwent clinical exam at study entry. Multivariate Cox regression accounting for repeated events was used to assess longitudinal predictors of fracture-related hospitalizations in Veterans Affairs Medical Centers 1996-2003.
RESULTS
One thousand four hundred and eighty-seven hospital admissions occurred among 315 participants, and 39 hospitalizations (2.6%) were for fracture treatment. Median length of stay was 35 days. Fracture-related complications occurred in 53%. Independent risk factors for admission were motor complete versus motor incomplete spinal cord injury (hazard ratio = 3.73, 95% CI = 1.46-10.50). There was a significant linear trend in risk with greater alcohol consumption after injury. Record review indicated that evaluation for osteoporosis was not obtained during these admissions.
CONCLUSIONS
Assessed prospectively, hospitalization in Veterans Affairs Medical Centers for low-impact fractures is more common in motor complete spinal cord injury and is associated with greater alcohol use after injury. Osteoporosis diagnosis and treatment considerations were not part of a clinical assessment, indicating the need for improved protocols that might prevent low-impact fractures and related admissions.
背景
骨质疏松症是脊髓损伤公认的并发症。我们报告称，运动完全性脊髓损伤和损伤后饮酒是因骨折治疗而住院的危险因素。临床评估并未包含骨质疏松症的诊断和治疗考虑，这表明需要改进临床方案。
介绍
治疗骨质疏松性长骨骨折通常会导致脊髓损伤患者住院时间延长。之前尚未描述导致住院风险的临床特征和因素。
方法
315 名脊髓损伤后 > 或 = 1 年的退伍军人完成了健康问卷并在研究开始时接受了临床检查。使用多变量 Cox 回归分析重复事件，以评估退伍军人事务医疗中心 1996-2003 年期间与骨折相关的住院的纵向预测因素。
结果
315 名参与者中发生了 1487 次住院，其中 39 次（2.6%）为骨折治疗。中位住院时间为 35 天。骨折相关并发症发生率为 53%。导致住院的独立危险因素为运动完全性与运动不完全性脊髓损伤（危险比=3.73，95%CI=1.46-10.50）。损伤后饮酒量越大，风险呈显著线性趋势。记录回顾表明，这些住院期间未进行骨质疏松症评估。
结论
前瞻性评估显示，在退伍军人事务医疗中心因低冲击力骨折而住院的情况在运动完全性脊髓损伤中更为常见，并且与损伤后饮酒量增加相关。骨质疏松症的诊断和治疗考虑并未纳入临床评估，这表明需要改进方案，以预防低冲击力骨折和相关住院。
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