Department of Orthopaedic Surgery, Asahikawa Kosei Hospital, Asahikawa, Japan.
J Neurosurg Spine. 2010 Aug;13(2):267-75. doi: 10.3171/2010.3.SPINE09364.
The present study was designed to determine clinical and radiographic characteristics of unhealed osteoporotic vertebral fractures (OVFs) and the role of fracture mobility and an intravertebral cleft in the regulation of pain symptoms in patients with an OVF.
Patients who had persistent low-back pain for 3 months or longer and a collapsed thoracic or lumbar vertebra that had an intervertebral cleft and abnormal mobility were referred to as having unhealed OVFs. Twenty-four patients with an unhealed OVF and 30 patients with an acute OVF were compared with regard to several clinical and radiographic features including the presence of an intravertebral fluid sign. Subsequently, the extent of dynamic mobility of the fractured vertebra was analyzed for correlation with the patients' age, duration of symptoms, back pain visual analog scale (VAS) score, and performance status. Finally, in cases of unhealed OVFs, the subgroup of patients with positive fluid signs was compared with the subgroup of patients with negative fluid signs.
Patients with an unhealed OVF were more likely to have a crush-type fracture, shorter vertebral height of the fractured vertebra, and a fracture with a positive fluid sign than those with an acute OVF. The extent of dynamic mobility of the vertebra correlated significantly with the VAS score in patients with an unhealed OVF. In addition, a significant correlation with the extent of dynamic vertebral mobility with performance status was seen in patients with an unhealed OVF and those with an acute OVF. Of the 24 patients with an unhealed OVF, 14 had a positive fluid sign in the affected vertebra. Patients with a positive fluid sign exhibited a statistically significantly greater extent of dynamic vertebral mobility, a higher VAS score, a higher performance status grade, and a greater likelihood of having a crush-type fracture than those with a negative fluid sign. All but 1 patient with an unhealed OVF and a positive fluid sign had an Eastern Cooperative Oncology Group Performance Status Grade 3 or 4 (bedridden most or all of the time). In sharp contrast, all 10 patients with an unhealed OVF and a negative fluid sign were Grade 1 or 2.
Unhealed OVFs form a group of fractures that are distinct from acute OVFs regarding radiographic morphometry and contents of the intravertebral cleft. Dynamic vertebral mobility serves as a primal pain determinant in patients with an unhealed OVF and potentially in those with an acute OVF. Fluid accumulation in the intravertebral cleft of unhealed OVFs likely reflects long-term bedridden positioning of the patients in daily activity.
本研究旨在确定未愈合的骨质疏松性椎体骨折（OVF）的临床和影像学特征，以及骨折活动度和椎体内裂隙在调节 OVF 患者疼痛症状中的作用。
将持续背痛 3 个月或以上且胸腰椎椎体塌陷伴椎间隙裂隙和异常活动的患者诊断为未愈合的 OVF。将 24 例未愈合的 OVF 患者和 30 例急性 OVF 患者进行比较，比较内容包括存在椎体内液征。随后，分析骨折椎体的动态活动度与患者年龄、症状持续时间、腰背疼痛视觉模拟评分（VAS）评分和活动状态之间的相关性。最后，在未愈合的 OVF 病例中，比较有阳性液征亚组和无阳性液征亚组。
与急性 OVF 患者相比，未愈合的 OVF 患者更可能发生压缩型骨折、骨折椎体的椎体高度更短、骨折伴阳性液征。未愈合的 OVF 患者的椎体活动度与 VAS 评分显著相关。此外，在未愈合的 OVF 患者和急性 OVF 患者中，与椎体活动度的相关性与活动状态显著相关。在 24 例未愈合的 OVF 患者中，14 例受累椎体有阳性液征。与阴性液征患者相比，阳性液征患者的椎体活动度明显更大，VAS 评分更高，活动状态评分更高，发生压缩型骨折的可能性更大。除 1 例患者外，所有未愈合的 OVF 患者均伴有阳性液征，其东部肿瘤协作组（ECOG）表现状态评分为 3 或 4 级（大部分或全部时间卧床）。相比之下，所有未愈合的 OVF 患者中有 10 例为阴性液征，其 ECOG 表现状态评分为 1 或 2 级。
未愈合的 OVF 在影像学形态测量和椎体内裂隙内容方面与急性 OVF 形成不同的骨折类型。在未愈合的 OVF 患者中，椎体活动度是原发性疼痛决定因素，在急性 OVF 患者中也可能如此。未愈合的 OVF 椎体内裂隙内的液体积聚可能反映了患者在日常活动中长期卧床的位置。
