Huang Kuo-Yuan, Lee Shang-Chi, Liu Wen-Lung, Wang Jung-Der
Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan.
Biostatistics Consulting Centre, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan.
J Clin Med. 2019 Dec 27;9(1):78. doi: 10.3390/jcm9010078.
There are still debates on the long-term outcome of treating pathological thoracolumbar fractures, including osteoporosis and oncologic problems, using vertebroplasty.
We collected 8625 patients with pathological thoracolumbar fractures (ICD-9-CM codes 733.13 combined with 805.2 or 805.4) between the years of 2003 to 2013, from the two million random samples from the National Health Insurance Research Database in Taiwan. Survival analysis was conducted to estimate the mortality risks of different treatments, including vertebroplasty (n = 1389), conventional open surgery (n = 1219), or conservative treatment (n = 6017). A multivariable Cox proportional hazard model was constructed for adjustment of age, gender, comorbidities and complications.
Crude incidence rate of patients with pathological thoracolumbar fractures in Taiwan gradually increased year by year. Compared with conservative treatment, conventional open surgery and vertebroplasty seemed to improve long-term survival with adjusted hazard ratios (aHR) of 0.80 (95% confidence interval (CI) 0.70-0.93), and 0.87 (95% CI 0.77-0.99), respectively. The survival advantage of vertebroplasty appeared more evident for those aged over 75. However, we were unable to rule out confounding by indication.
Although conventional open surgery would usually be the best choice for the treatment of patients with pathological thoracolumbar fractures, database information from current real-world practice appears to support vertebroplasty as a viable choice for elderly people over 75 years of age.
对于使用椎体成形术治疗包括骨质疏松和肿瘤问题在内的病理性胸腰椎骨折的长期疗效仍存在争议。
我们从台湾国民健康保险研究数据库的两百万随机样本中收集了2003年至2013年间8625例病理性胸腰椎骨折患者（国际疾病分类第九版临床修正本编码733.13合并805.2或805.4）。进行生存分析以估计不同治疗方法的死亡风险，包括椎体成形术（n = 1389）、传统开放手术（n = 1219）或保守治疗（n = 6017）。构建多变量Cox比例风险模型以调整年龄、性别、合并症和并发症。
台湾病理性胸腰椎骨折患者的粗发病率逐年逐渐增加。与保守治疗相比，传统开放手术和椎体成形术似乎能改善长期生存率，调整后的风险比（aHR）分别为0.80（95%置信区间（CI）0.70 - 0.93）和0.87（95%CI 0.77 - 0.99）。椎体成形术对75岁以上患者的生存优势更为明显。然而，我们无法排除指征性混杂因素。
虽然传统开放手术通常是治疗病理性胸腰椎骨折患者的最佳选择，但当前实际临床实践的数据库信息似乎支持椎体成形术作为75岁以上老年人的一种可行选择。
