Veterans Affairs Medical Center, Memphis, TN, USA; Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
J Bone Miner Res. 2014 Feb;29(2):432-9. doi: 10.1002/jbmr.2050.
In the United States, there are over 200,000 men with spinal cord injuries (SCIs) who are at risk for lower limb fractures. The risk of mortality after fractures in SCI is unknown. This was a population-based, cohort study of all male veterans (mean age 54.1; range, 20.3-100.5 years) with a traumatic SCI of at least 2 years' duration enrolled in the Veterans Affairs (VA) Spinal Cord Dysfunction Registry from FY2002 to FY2010 to determine the association between lower extremity fractures and mortality. Mortality for up to 5 years was determined. The lower extremity fracture rate was 2.14 per 100 patient-years at risk for at least one fracture. In unadjusted models and in models adjusted for demographic, SCI-related factors, healthcare use, and comorbidities, there was a significant association between incident lower extremity fracture and increased mortality (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.17-1.63; HR, 1.36; 95% CI, 1.15-1.61, respectively). In complete SCI, the hazard of death after lower extremity fracture was also increased (unadjusted model: HR, 1.46; 95% CI, 1.13-1.89; adjusted model: HR, 1.32; 95% CI, 1.02-1.71). In fully-adjusted models, the association of incident lower extremity fracture with increased mortality was substantially greater in older men (age ≥50 years) for the entire cohort (HR, 3.42; 95% CI, 2.75-4.25) and for those with complete SCI (HR, 3.13; 95% CI, 2.19-4.45), compared to younger men (age <50 years) (entire cohort: HR, 1.42; 95% CI, 0.94-2.14; complete SCI: HR, 1.71; 95% CI, 0.98-3.01). Every additional point in the Charlson comorbidity index was associated with a 10% increase in the hazard of death in models involving the entire cohort (HR, 1.11; 95% CI, 1.09-1.13) and also in models limited to men with complete SCI (HR, 1.10; 95% CI, 1.06-1.15). These data support the concept that both the fracture itself and underlying comorbidities are drivers of death in men with SCI.
在美国，有超过 20 万名脊髓损伤（SCI）男性患者存在下肢骨折风险。SCI 患者骨折后的死亡率尚不清楚。这是一项基于人群的队列研究，纳入了所有在退伍军人事务部（VA）脊髓功能障碍登记处登记的、至少有 2 年外伤性 SCI 病史的男性退伍军人（平均年龄 54.1 岁；范围 20.3-100.5 岁），以确定下肢骨折与死亡率之间的关系。随访了长达 5 年的时间，以确定死亡率。至少发生一次骨折的患者中，下肢骨折发生率为每 100 患者-年 2.14 例。在未调整模型和调整了人口统计学、SCI 相关因素、医疗保健使用和合并症的模型中，下肢骨折与死亡率升高显著相关（风险比 [HR]，1.38；95%置信区间 [CI]，1.17-1.63；HR，1.36；95% CI，1.15-1.61）。在完全性 SCI 中，下肢骨折后死亡的风险也增加（未调整模型：HR，1.46；95% CI，1.13-1.89；调整模型：HR，1.32；95% CI，1.02-1.71）。在充分调整的模型中，与年龄较轻的男性（年龄<50 岁）相比，下肢骨折与死亡率升高的相关性在年龄较大的男性（年龄≥50 岁）中更为显著（整个队列：HR，3.42；95% CI，2.75-4.25；完全性 SCI：HR，3.13；95% CI，2.19-4.45）。Charlson 合并症指数每增加 1 分，整个队列模型（HR，1.42；95% CI，0.94-2.14）和仅针对完全性 SCI 患者的模型（HR，1.71；95% CI，0.98-3.01）中死亡风险都会增加 10%。在包括整个队列的模型（HR，1.11；95% CI，1.09-1.13）和仅针对完全性 SCI 患者的模型（HR，1.10；95% CI，1.06-1.15）中，Charlson 合并症指数每增加 1 分，都会导致死亡风险增加 10%。这些数据支持这样一种观点，即骨折本身和潜在的合并症都是 SCI 患者死亡的驱动因素。
