Spine Center, Shiraniwa Hospital, Nara, Japan.
Spine (Phila Pa 1976). 2013 May 15;38(11):E641-8. doi: 10.1097/BRS.0b013e31828ced9d.
Prospective multicenter study.
To examine whether initial conservative treatment interventions for osteoporotic vertebral fractures (OVF) influence patient outcomes.
OVFs have been described as stable spinal injuries and, in most cases, are managed well with conservative treatment. However, systematic treatments for OVF have not been clearly established.
A total of 362 patients with OVF (59 males and 303 females; mean age, 76.3 yr) from 25 institutes were enrolled in this clinical study. All the patients were treated conservatively without any surgical interventions. The patient outcomes were evaluated 6 months after the fractures on the basis of Short Form-36 (SF-36) physical component summary (PCS) and mental component summary (MCS), activities of daily living (the Japanese long-term care insurance system), back pain (visual analogue scale), cognitive status (mini-mental state examination), and vertebral collapse, which were used as response variables. Furthermore, brace type, hospitalization, bisphosphonates after injury, and painkillers after injury were explanatory variables for the treatment interventions. To evaluate the independent effects of treatment interventions on patient outcomes, we performed multivariate logistic regression analyses and obtained odds ratios that were adjusted for the potential confounding effects of age, sex, level of fracture, presence of middle-column injury, pain visual analogue scale at enrollment, mini-mental state examination score at enrollment, and previous use of steroids.
There was no significant difference for treatment intervention factors including brace type, hospitalization, bisphosphonates after injury, and painkillers after injury. For adjusting factors, the presence of middle-column injury was significantly associated with SF-36 PCS ≤ 40, reduced activities of daily living, prolonged back pain, and vertebral collapse. Female sex and advanced age were associated with SF-36 PCS ≤ 40. Low mini-mental state examination scores at enrollment were associated with SF-36 PCS ≤ 40 and reduced activities of daily living. The previous use of steroids was associated with SF-36 MCS ≤ 40, prolonged back pain, and vertebral collapse. No other examined variables were significant risk factors for patient outcomes.
These results showed that treatment intervention factors did not affect patient outcomes 6 months after OVF. Middle-column injury was a significant risk factor for both clinical and radiological outcomes. In the future, establishing systematic treatments for cases with middle-column injuries is needed.
前瞻性多中心研究。
研究骨质疏松性椎体骨折（OVF）的初始保守治疗干预是否影响患者预后。
OVF 被描述为稳定的脊柱损伤，在大多数情况下，采用保守治疗即可得到很好的治疗。然而，OVF 的系统治疗尚未明确。
共纳入 25 家机构的 362 例 OVF 患者（59 例男性，303 例女性；平均年龄 76.3 岁），所有患者均未接受任何手术干预而采用保守治疗。骨折后 6 个月，根据简明 36 健康调查量表（SF-36）的生理成分综合评分（PCS）和心理成分综合评分（MCS）、日常生活活动（日本长期护理保险制度）、腰背疼痛（视觉模拟评分）、认知状态（简易精神状态检查）和椎体塌陷情况评估患者结局。此外，支具类型、住院时间、骨折后使用双膦酸盐和骨折后使用止痛药作为治疗干预的解释变量。为评估治疗干预对患者结局的独立影响，我们进行了多变量逻辑回归分析，并获得了经年龄、性别、骨折水平、中柱损伤存在、入组时腰背疼痛视觉模拟评分、入组时简易精神状态检查评分和既往使用类固醇调整后具有统计学意义的比值比。
支具类型、住院时间、骨折后使用双膦酸盐和骨折后使用止痛药等治疗干预因素无显著差异。对于调整因素，中柱损伤的存在与 SF-36 PCS≤40、日常生活活动受限、腰背疼痛持续时间延长和椎体塌陷有关。女性和高龄与 SF-36 PCS≤40 有关。入组时简易精神状态检查评分较低与 SF-36 PCS≤40 和日常生活活动受限有关。既往使用类固醇与 SF-36 MCS≤40、腰背疼痛持续时间延长和椎体塌陷有关。其他检查变量均不是患者结局的危险因素。
这些结果表明，OVF 后 6 个月时，治疗干预因素并不影响患者结局。中柱损伤是临床和影像学结局的一个重要危险因素。未来需要为中柱损伤患者建立系统的治疗方法。
2。
