Nakamae Toshio, Fujimoto Yoshinori, Yamada Kiyotaka, Hiramatsu Takeshi, Hashimoto Takashi, Olmarker Kjell, Adachi Nobuo
Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.
Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.
J Orthop Sci. 2017 Mar;22(2):201-206. doi: 10.1016/j.jos.2016.12.002. Epub 2017 Jan 9.
With aging of the population, the numbers of osteoporotic vertebral fractures with intravertebral cleft have been increasing. However, the details of clinical symptoms of osteoporotic vertebral fractures with intravertebral cleft are poorly understood. The purpose of this study was to evaluate the relationship between clinical symptoms of osteoporotic vertebral fractures with intravertebral cleft and radiographic findings.
Two hundred seventeen patients with single-level osteoporotic vertebral fractures with intravertebral cleft were examined. Clinical symptoms were evaluated using Numerical Rating Scale for back pain and the Oswestry Disability Index for physical disability. The presence of delayed neurologic deficit was also detected. Radiography and computed tomography were used to measure local kyphotic angle and vertebral instability and to detect the presence of posterior wall fracture of the vertebral body. Correlations between clinical symptoms of osteoporotic vertebral fractures with intravertebral cleft and radiographic findings were investigated.
Mean Numerical Rating Scale and Oswestry Disability Index were 7.4 and 58.0%, respectively. Delayed neurologic deficit occurred in 41 patients (19%). The mean local kyphotic angle, vertebral instability, and rate of posterior wall fracture of the vertebral body were 19.4°, 7.3°, and 91%, respectively. Numerical Rating Scale and Oswestry Disability Index were statistically correlated with vertebral instability but not with local kyphotic angle and presence of posterior wall fracture. In the patients with delayed neurologic deficit, vertebral instability was significantly higher and posterior wall fractures were significantly more frequent than in the patients without delayed neurologic deficit. Local kyphotic angle was not correlated with delayed neurologic deficit.
Vertebral instability is a factor causing symptoms of osteoporotic vertebral fractures with intravertebral cleft. In addition, vertebral instability may be the predominant cause of delayed neurologic deficit. To manage osteoporotic vertebral fractures with intravertebral cleft and delayed neurologic deficit efficiently, it may be important to control vertebral instability of osteoporotic vertebral fractures.
随着人口老龄化，伴有椎体内裂隙的骨质疏松性椎体骨折数量不断增加。然而，伴有椎体内裂隙的骨质疏松性椎体骨折的临床症状细节尚不清楚。本研究的目的是评估伴有椎体内裂隙的骨质疏松性椎体骨折的临床症状与影像学表现之间的关系。
对217例单节段伴有椎体内裂隙的骨质疏松性椎体骨折患者进行检查。使用背痛数字评定量表和身体残疾的奥斯维斯特里残疾指数评估临床症状。还检测了延迟神经功能缺损的存在。采用X线摄影和计算机断层扫描测量局部后凸角和椎体不稳定情况，并检测椎体后壁骨折的存在。研究伴有椎体内裂隙的骨质疏松性椎体骨折的临床症状与影像学表现之间的相关性。
背痛数字评定量表和奥斯维斯特里残疾指数的平均值分别为7.4和58.0%。41例患者（19%）出现延迟神经功能缺损。局部后凸角、椎体不稳定和椎体后壁骨折发生率的平均值分别为19.4°、7.3°和91%。背痛数字评定量表和奥斯维斯特里残疾指数与椎体不稳定在统计学上相关，但与局部后凸角和椎体后壁骨折的存在无关。在出现延迟神经功能缺损的患者中，椎体不稳定明显更高，后壁骨折明显比未出现延迟神经功能缺损的患者更频繁。局部后凸角与延迟神经功能缺损无关。
椎体不稳定是导致伴有椎体内裂隙的骨质疏松性椎体骨折症状的一个因素。此外，椎体不稳定可能是延迟神经功能缺损的主要原因。为了有效治疗伴有椎体内裂隙和延迟神经功能缺损的骨质疏松性椎体骨折，控制骨质疏松性椎体骨折的椎体不稳定可能很重要。
