Lotan Raphael, Smorgick Yossi, Anekstein Yoram, Rudik Oren, Prosso Ilia, Hershkovich Oded
Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Spine Unit, Assaf Harofeh Medical Center, Zerifin, Israel, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Global Spine J. 2022 Sep;12(7):1443-1448. doi: 10.1177/2192568220982282. Epub 2021 Jan 12.
Retrospective cohort.
We aimed to compare a large cohort of patients with vertebral compression fractures (VCF) treated in 2 centers using different protocols (conservative vs BKP) and compare mortality rates on a long-term follow-up.
Retrospective cohort held in 2 medical centers (W and AH). All patients admitted with VCF from November 2008 to January 2015 were enrolled in the study. Exclusion criteria were patients admitted with non-osteoporotic pathological fractures (such as metastatic or MM).
Our study included 208 patients treated for VCF, 127 were treated with BKP (88 females, 69.3%) and 81 were treated conservatively (59 females, 72.8%). Patients from Centre W were older and frailer compared to the patients from AH center (Average age 75.12 ± 11.16 vs 69.13 ± 9.61 years and Frailty score of 0.16 ± 0.1 vs 0.12 ± 0.1 respectively, T-test, p < 0.01 for both). Hazard ratios (HR) for age, female gender and frailty were significant for increased mortality, frailty had the highest HR of 182.42 (CI 29.05-1145.33, p < 0.01). Multivariate Cox model was fitted and after accounting for Gender, Age and Frailty, no significant difference was found between the 2 medical centers mortality rates (p = 0.59), thus no difference in mortality rates between BKP and conservative treatment in our study.
long-term follow-up following BKP treatment for VCF did not show a reduced mortality rate compared to conservative treatment after accounting for frailty, age and gender. Frailty was the most important factor in predicting mortality. Further RCTs are needed to compare the quality of life differences between the 2 treatment strategies.
回顾性队列研究。
我们旨在比较在两个中心采用不同方案（保守治疗与球囊扩张椎体后凸成形术[BKP]）治疗的一大群椎体压缩骨折（VCF）患者，并比较长期随访中的死亡率。
在两个医疗中心（W和AH）进行回顾性队列研究。纳入2008年11月至2015年1月期间因VCF入院的所有患者。排除标准为因非骨质疏松性病理性骨折（如转移性或多发性骨髓瘤骨折）入院的患者。
我们的研究纳入了208例接受VCF治疗的患者，其中127例接受BKP治疗（88例女性，占69.3%），81例接受保守治疗（59例女性，占72.8%）。与AH中心的患者相比，W中心的患者年龄更大且身体更虚弱（平均年龄分别为75.12±11.16岁和69.13±9.61岁，虚弱评分分别为0.16±0.1和0.12±0.1，均为t检验，p<0.01）。年龄、女性性别和虚弱的风险比（HR）对死亡率增加具有显著意义，虚弱的HR最高，为182.42（95%置信区间[CI]为29.05 - 1145.33，p<0.01）。拟合多变量Cox模型，在考虑性别、年龄和虚弱因素后，两个医疗中心的死亡率之间未发现显著差异（p = 0.59），因此在我们的研究中BKP治疗与保守治疗的死亡率无差异。
在考虑虚弱、年龄和性别因素后，VCF患者接受BKP治疗后的长期随访显示与保守治疗相比死亡率并未降低。虚弱是预测死亡率的最重要因素。需要进一步的随机对照试验来比较两种治疗策略之间的生活质量差异。
