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, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 579-8026, Japan.
Arch Osteoporos. 2021 Feb 1;16(1):20. doi: 10.1007/s11657-021-00884-y.
This study demonstrated that number of three specific radiological risk factors (MR T2WI confined high-intensity pattern and diffuse low-intensity pattern, thoracolumbar vertebrae involvement, middle column injury) added prognostic information for delayed union, kyphotic deformity, and prolonged pain.
Delayed union after osteoporotic vertebral fracture (OVF) causes prolonged pain, QOL impairment, progression of collapse, kyphotic deformity, and neurologic impairment. Some specific radiological findings can be useful for predicting delayed union. We aimed to explore the prevalence and concomitance of various types of radiological risk factors for delayed union after osteoporotic vertebral fracture (OVF) and to assess the impact of risk factor number on clinical outcomes.
A total of 508 patients with fresh OVF from 25 institutes were evaluated. All patients were treated conservatively without surgical interventions. At the 6-month follow-up, the patients were classified into bone union and delayed union groups based on plain X-ray findings. We examined the presence and absence of three specific radiological risk factors (MR T2WI confined high-intensity pattern and diffuse low-intensity pattern, thoracolumbar vertebrae involvement, middle column injury) and analyzed clinical outcomes according to numbers of radiological risk factors.
Delayed union was observed in 101 patients (19.9%) at the 6-month follow-up. The most common radiological risk factor was thoracolumbar vertebrae involvement (73.8%), followed by middle column injury (33.9%) and specific MRI findings (T2WI confined high-intensity pattern and diffuse low-intensity pattern) (29.7%). Overall, 85 (16.7%) patients had zero radiological risk factors, 212 (42.7%) had one, 137 (27.0%) had two, and 69 (13.6%) had three. When assessing the number of radiographic risk factors which included the MRI findings (the 3-risk factor method), the odds ratio for delayed union after acute OVF was 5.8 in the 2/3-risk factor group and 13.1 in the 3/3-risk factor group. Even when assessing the number of radiographic risk factors without MRI findings (2-risk factor method), the odds ratio was 3.2 in the 1/2-risk factor group and 10.2 in the 2/2-risk factor group.
Number of radiological risk factors added prognostic information for delayed union, kyphotic deformity, and prolonged pain.
本研究表明，3 种特定影像学危险因素（MR T2WI 局限性高信号和弥漫性低信号、胸腰椎受累、中柱损伤）的数量为延迟愈合、后凸畸形和疼痛延长提供了预后信息。
骨质疏松性椎体骨折（OVF）后延迟愈合会导致疼痛持续时间延长、生活质量受损、塌陷进展、后凸畸形和神经功能障碍。一些特定的影像学发现可有助于预测延迟愈合。本研究旨在探讨骨质疏松性椎体骨折（OVF）后各种类型的影像学危险因素的发生率和共存情况，并评估危险因素数量对临床结局的影响。
对来自 25 个机构的 508 例新鲜 OVF 患者进行评估。所有患者均接受保守治疗，未行手术干预。在 6 个月的随访中，根据 X 线片检查结果将患者分为骨愈合组和延迟愈合组。我们检查了 3 种特定影像学危险因素（MR T2WI 局限性高信号和弥漫性低信号、胸腰椎受累、中柱损伤）的存在和不存在情况，并根据影像学危险因素的数量分析了临床结局。
在 6 个月的随访中，101 例（19.9%）患者出现延迟愈合。最常见的影像学危险因素是胸腰椎受累（73.8%），其次是中柱损伤（33.9%）和特定 MRI 表现（T2WI 局限性高信号和弥漫性低信号）（29.7%）。总体而言，85 例（16.7%）患者无任何影像学危险因素，212 例（42.7%）有 1 个，137 例（27.0%）有 2 个，69 例（13.6%）有 3 个。在评估包括 MRI 表现的影像学危险因素数量（3 项危险因素法）时，急性 OVF 后发生延迟愈合的比值比在 2/3 项危险因素组为 5.8，在 3/3 项危险因素组为 13.1。即使在评估不包括 MRI 表现的影像学危险因素数量（2 项危险因素法）时，在 1/2 项危险因素组的比值比为 3.2，在 2/2 项危险因素组的比值比为 10.2。
影像学危险因素的数量增加了对延迟愈合、后凸畸形和疼痛延长的预后信息。
