Suzuki Nobuyuki, Ogikubo Osamu, Hansson Tommy
Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
Eur Spine J. 2009 Jan;18(1):77-88. doi: 10.1007/s00586-008-0847-y. Epub 2008 Dec 12.
The level of the acute osteoporotic vertebral fracture, fracture type and grade of fracture deformation were determined in 107 consecutive patients and related to pain, disability, activities of daily living (ADL) and quality of life (QoL) after 3 weeks, 3, 6 and 12 months. Two-thirds of the fractured patients were women and with a similar average age, around 75 years, as the men. Fifty-eight of the acute fractures were located in the thoracic spine and 49 in the lumbar spine and predominantly at the Th12 and L1 levels. Sixty-nine percent of the fractures were wedge, 19% concave and 12% crush fractures. There were 22 mildly, 50 moderately and 35 severely deformed vertebrae. The grade of fracture deformation was not related to gender, age or fracture location. Severely deformed vertebrae predominantly (92%) occurred among the crush fracture type. One year after the fracture, irrespective of fracture level, fracture type or grade of fracture deformation, 4/5 still had pronounced pain and deteriorated QoL. Initial severe fracture deformation by far was the worst prognostic factor for severe lasting pain and disability, and deterioration of ADL and QoL. Factors like fracture level, lumbar fractures tended to improve steadily while thoracic deteriorated, type of fracture, the wedge and concave resulting in less pain and better QoL than the crush fracture type and gender influenced to a lesser extent the outcomes during the year after the acute fracture.
对107例连续性患者的急性骨质疏松性椎体骨折水平、骨折类型及骨折变形程度进行了测定，并与3周、3个月、6个月及12个月后的疼痛、残疾情况、日常生活活动能力（ADL）及生活质量（QoL）进行了关联分析。三分之二的骨折患者为女性，其平均年龄与男性相似，约75岁。58例急性骨折位于胸椎，49例位于腰椎，主要发生在胸12和腰1水平。69%的骨折为楔形，19%为凹陷性，12%为压缩性骨折。有22例椎体轻度变形，50例中度变形，35例重度变形。骨折变形程度与性别、年龄或骨折部位无关。重度变形椎体主要（92%）发生在压缩性骨折类型中。骨折后1年，无论骨折水平、骨折类型或骨折变形程度如何，五分之四的患者仍有明显疼痛且生活质量恶化。迄今为止，初始严重骨折变形是严重持续疼痛和残疾以及ADL和QoL恶化的最糟糕预后因素。诸如骨折水平等因素，腰椎骨折往往会稳步改善而胸椎骨折则会恶化；骨折类型方面楔形和凹陷性骨折导致的疼痛比压缩性骨折类型轻且生活质量更好；性别在急性骨折后的一年中对结果的影响较小。
