与保守治疗后新发椎体压缩性骨折相关的风险因素：一项回顾性观察研究。

A risk factor associated with subsequent new vertebral compression fracture after conservative therapy for patients with vertebral compression fracture: a retrospective observational study.

机构信息

Department of Orthopedic Surgery, Akita hospital, 2-6-12 Takara, Chiryu City, Aichi, 472-0056, Japan.

Department of Radiology, Akita Hospital, Chiryu, Aichi, Japan.

出版信息

Arch Osteoporos. 2020 Jan 3;15(1):9. doi: 10.1007/s11657-019-0679-x.

DOI:10.1007/s11657-019-0679-x

PMID:31897621

Abstract

UNLABELLED

Lumbar BMD and functional recovery in the acute period were independently strongly associated with subsequent new VCF after hospital conservative therapy for patients with new fragility VCFs. Functional recovery was related with age, pain intensity during first month after hospitalization, VCF past history and multiple new VCFs.

PURPOSE

This study aimed to determine the factors independently associated with the subsequent vertebral compression fracture (VCF) after hospital conservative therapy in patients with new fragility VCFs and parameters related with functional recovery in the acute period.

METHODS

Subsequent VCF (n = 37) was defined as patients who sustained a new VCF within 9 months after new VCF, whereas patients without a new VCF were classified as non-subsequent VCF (n = 179). Logistic regression analysis was performed to determine independent factors associated with the subsequent VCF, including patients' characteristics, past histories, number of new VCFs, bone mineral density (BMD), lumbar sagittal alignment, fractured vertebral body height, spine muscle mass, pain intensity, corset types, medications for osteoporosis and pain relief, recovery ratio of functional independence measure (FIM) and bone union. Correlation coefficients were accessed between the FIM recovery ratio and continuous variable parameters, while intergroup comparisons or analysis of variance was conducted to examine significant differences in the FIM recovery ratio for categorical variable parameters.

RESULTS

Lumbar BMD, FIM recovery ratio at the first month after hospitalization and segmental Cobb angle were significantly independently associated with subsequent VCF (odds ratio: 27.8, 9.6 and 1.1, respectively). The FIM recovery ratio was moderately negatively correlated with age and pain intensity and was significantly worse in patients with multiple new VCFs or past history of VCF.

CONCLUSIONS

Conservative therapies focused on lumbar BMD, functional recovery and pain relief in the acute period may be useful in preventing subsequent VCF.

摘要

背景

对于新发脆性椎体骨折（VCF）患者，经医院保守治疗后，其腰椎骨密度（BMD）和急性期功能恢复与随后新发 VCF 独立且强烈相关。功能恢复与年龄、住院后第一个月疼痛强度、VCF 既往史和多个新发 VCF 相关。

目的

本研究旨在确定新发脆性 VCF 患者经医院保守治疗后与随后发生 VCF 相关的独立因素，并确定急性期功能恢复相关参数。

方法

新发 VCF（n=37）定义为新发 VCF 后 9 个月内发生新 VCF 的患者，而无新发 VCF 的患者被归类为非新发 VCF（n=179）。采用 logistic 回归分析确定与随后 VCF 相关的独立因素，包括患者特征、既往史、新发 VCF 数量、BMD、腰椎矢状面排列、骨折椎体高度、脊柱肌肉质量、疼痛强度、支具类型、骨质疏松症和止痛药物、功能独立性测量（FIM）恢复率和骨愈合。评估 FIM 恢复率与连续变量参数之间的相关系数，同时进行组间比较或方差分析，以检查 FIM 恢复率在分类变量参数上的显著差异。