Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany; Rehabilitation Center, St. Josef-Stift Sendenhorst, Sendenhorst, Germany; Department of Orthopedic and Trauma Surgery, University Hospital of the Paracelsus Medical University (PMU), Nuremberg site, Nürnberg, Germany; Department of Orthopedic and Trauma Surgery, Special Orthopedic Surgery, Osteology (DVO, German Osteology Society), University Hospital of Düsseldorf, Düsseldorf, Germany; Department of Orthopedics and Trauma Surgery, University Hospital Cologne, Cologne, Germany; Department of Anesthesiology and Intensive Care Medicine, Paul Gerhardt Stift Hospital, Lutherstadt Wittenberg, Germany; Interdisciplinary Center for Spine and Scoliosis therapy. Malteser Waldkrankenhaus St. Marien, Erlangen, Germany.
Dtsch Arztebl Int. 2021 Oct 8;118(40):670-677. doi: 10.3238/arztebl.m2021.0295.
The prevalence of osteoporotic vertebral body fractures in Europe is 18-26%. Although most of these injuries can be treated conservatively, the underlying concepts have not been defined clearly or uniformly. In this article, we present the current state of the evidence on the diagnosis and conservative treatment of osteoporotic fractures of the thoracic and lumbar vertebrae.
A systematic review of the literature up to May 2020 was carried out in the PubMed and Web of Science Core Collection databases. 549 articles were identified, of which 36 were suitable for inclusion in the review. Articles were sought in the areas of diagnosis, provision of physical aids, pharmacotherapy, physiotherapy, and treatments from the realm of alternative medicine.
The primary diagnostic technique was conventional x-ray in two planes (with the patient standing, if possible), which had 51.3% sensitivity and 75% specificity. If a fracture was suspected, magnetic resonance imaging (MRI) of the entire spine and regional computed tomography (CT) were carried out. The overall state of the evidence on treatment is poor; the best available evidence is for exercise therapy and physiotherapy, which are supported by three level I and four level II studies. Improvements were seen mainly in mobility and a reduced fear of falling. The use of an active orthosis can be useful as well. No evidence was found on the use of drugs or alternative medicine exclusively in the conservative treatment of osteoporotic vertebral body fractures.
It is reasonable to evaluate instability with imaging repeatedly, at regular intervals, over a period of six months. There is still a lack of reliable data on the optimal intensity and duration of physiotherapy, and on the use of orthoses.
欧洲骨质疏松性椎体骨折的患病率为 18-26%。尽管大多数此类损伤可以通过保守治疗来治疗，但基础概念尚未明确或统一。在本文中，我们介绍了目前关于胸腰椎骨质疏松性骨折的诊断和保守治疗的证据状况。
在 PubMed 和 Web of Science Core Collection 数据库中对截至 2020 年 5 月的文献进行了系统回顾。共确定了 549 篇文章，其中 36 篇适合纳入综述。在诊断、提供物理辅助、药物治疗、物理治疗和替代医学治疗领域进行了文献检索。
主要的诊断技术是常规 X 射线（如果可能的话，患者站立位），其灵敏度为 51.3%，特异性为 75%。如果怀疑有骨折，则对整个脊柱和局部 CT 进行磁共振成像（MRI）检查。总体而言，治疗的证据状况较差；最可用的证据是针对运动疗法和物理治疗的证据，这些证据得到了三项一级和四项二级研究的支持。主要改善了移动性和跌倒恐惧的减少。主动矫形器的使用也可能有用。在保守治疗骨质疏松性椎体骨折方面，没有发现专门使用药物或替代医学的证据。
合理的做法是在六个月的时间内定期重复进行影像学评估以评估不稳定情况。关于物理治疗的最佳强度和持续时间以及矫形器的使用，仍然缺乏可靠的数据。
