Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
Department of Orthopaedic Surgery, Seikeikai Hospital, Osaka, Japan.
Osteoporos Int. 2020 Jun;31(6):1089-1095. doi: 10.1007/s00198-020-05338-8. Epub 2020 Feb 14.
This study revealed the change in the paravertebral muscles in patients with osteoporotic vertebral fracture. Increased pain is likely to be the driver for reduced activity, reduced activities of daily living, and consequent increase in fat infiltration of the paravertebral muscles, assumed to be secondary to reduced activity level or, conversely, partial immobilization.
To reveal the time courses and impact of the paravertebral muscles (PVMs) on the healing process of osteoporotic vertebral fractures and risk factors for PVM decrease.
Consecutive patients with symptomatic osteoporotic vertebral fractures were enrolled in 11 hospitals. At enrollment and 3- and 6-month follow-up, PVMs, including the multifidus and erector spinae, were examined using magnetic resonance imaging (MRI). The PVM cross-sectional area (CSA) and fat signal fraction (FSF) were measured at L3. Low back pain (LBP), activities of daily living (ADLs), and risk factors for PVM decrease at the 6-month follow-up were investigated. PVM decrease was defined as > 1 standard deviation decrease of the CSA or > 1 standard deviation increase of the FSF.
Among 153 patients who completed the 6-month follow-up, 117 (92 women, 79%) had MRI of L3 at enrollment and 3- and 6-month follow-up (mean age at enrollment, 78.5 years). The CSA did not change 6 months from onset (p for trend = 0.634), whereas the FSF significantly increased (p for trend = 0.033). PVM decrease was observed in 30 patients (26%). LBP was more severe, and delayed union was more frequent in patients with PVM decrease (p = 0.021 mixed-effect model and p = 0.029 chi-square test, respectively). The risk factors for PVM decrease were ADL decline at the 3-month follow-up (adjusted odds ratio = 5.35, p = 0.026).
PVM decrease was significantly related to LBP and delayed union after osteoporotic vertebral fracture onset. ADL decline at the 3-month follow-up was a risk factor for PVM decrease. Therefore, restoring ADLs within 3 months after onset is important.
揭示骨质疏松性椎体骨折患者椎旁肌的变化。疼痛加剧可能导致活动减少、日常生活活动能力下降，继而椎旁肌脂肪浸润增加，这被认为是活动水平降低的结果，或者相反，是部分固定的结果。
连续纳入 11 家医院的有症状骨质疏松性椎体骨折患者。在入组时以及 3 个月和 6 个月随访时，使用磁共振成像（MRI）检查椎旁肌（包括多裂肌和竖脊肌）。在 L3 处测量椎旁肌横截面积（CSA）和脂肪信号分数（FSF）。在 6 个月随访时调查腰痛（LBP）、日常生活活动（ADL）以及椎旁肌减少的危险因素。将 CSA 减少>1 个标准差或 FSF 增加>1 个标准差定义为椎旁肌减少。
在完成 6 个月随访的 153 名患者中，117 名（92 名女性，79%）在入组时以及 3 个月和 6 个月随访时进行了 L3 的 MRI（入组时的平均年龄为 78.5 岁）。从发病到 6 个月时 CSA 没有变化（趋势 p=0.634），而 FSF 显著增加（趋势 p=0.033）。30 名患者（26%）出现椎旁肌减少。椎旁肌减少的患者 LBP 更严重，且延迟愈合更常见（p=0.021 混合效应模型和 p=0.029 卡方检验）。椎旁肌减少的危险因素是 3 个月随访时 ADL 下降（调整后的优势比=5.35，p=0.026）。
骨质疏松性椎体骨折发病后，椎旁肌减少与腰痛和延迟愈合显著相关。3 个月随访时 ADL 下降是椎旁肌减少的危险因素。因此，发病后 3 个月内恢复 ADL 非常重要。
