Su Wen-Chin, Wu Wen-Tien, Peng Cheng-Huan, Yu Tzai-Chiu, Lee Ru-Ping, Wang Jen-Hung, Yeh Kuang-Ting
Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Geriatr Orthop Surg Rehabil. 2022 May 6;13:21514593221100238. doi: 10.1177/21514593221100238. eCollection 2022.
Fragility vertebral compression fractures (VCFs) are of major concern due to aging populations worldwide, which may occur after a fall from standing or due to severe osteoporosis, impacting greatly the life quality of the elderly. This study thus determined the factors independently associated with poor functional recovery from a new VCF and changes in sagittal spinal alignment after vertebroplasty in elderly patients with osteoporosis.
The data were collected from patients older than 70 years and diagnosed with a new VCF. Logistic regression analysis was performed to determine factors independently associated with function and radiographic status.
We enrolled 8 male and 34 female patients with a mean age of 80.74 ± 8.31 years between January and July 2020. Compared with preoperative data, post-vertebroplasty lumbar sagittal alignments and functional scores improved significantly, and function recovered gradually over 12 weeks. Climbing stairs was the most influential performance indicator at the beginning of the recovery process. At each postoperative follow-up, changes in the C7-sacrum sagittal vertical axis exhibited an influence on functional recovery. Male patients were better able to move from a chair to a bed at the 2-week postoperative follow-up, and positive changes in the spino-sacral angle led to improved function in terms of stair climbing at the 6-week postoperative follow-up.
Vertebroplasty seemed to be effective for functional recovery related to sagittal spinal alignment improvement of the elderly with VCFs during postoperative 12 weeks, which may be a critical stage for the recovery for their life activities. The recovery rate for stair climbing after vertebroplasty was slower than for the other functional performance indicators in our study. In addition, if a patient was unable to demonstrate a marked improvement in sagittal alignment, they were likely to have ongoing impaired function and a poor prognosis after surgery.
由于全球人口老龄化，脆性椎体压缩骨折（VCF）备受关注，其可能因从站立位跌倒或严重骨质疏松而发生，对老年人的生活质量影响极大。因此，本研究确定了老年骨质疏松性椎体压缩骨折患者椎体成形术后功能恢复不佳及矢状面脊柱排列变化的独立相关因素。
收集70岁以上诊断为新发椎体压缩骨折患者的数据。进行逻辑回归分析以确定与功能及影像学状态独立相关的因素。
2020年1月至7月，我们纳入了8例男性和34例女性患者，平均年龄为80.74±8.31岁。与术前数据相比，椎体成形术后腰椎矢状面排列和功能评分显著改善，且功能在12周内逐渐恢复。在恢复过程开始时，爬楼梯是最具影响力的表现指标。在每次术后随访中，C7-骶骨矢状垂直轴的变化对功能恢复有影响。男性患者在术后2周时从椅子移动到床上的能力更好，而棘-骶角的正向变化导致术后6周时爬楼梯功能改善。
椎体成形术似乎对老年椎体压缩骨折患者术后12周内与矢状面脊柱排列改善相关的功能恢复有效，这可能是其生活活动恢复的关键阶段。在我们的研究中，椎体成形术后爬楼梯的恢复速度比其他功能表现指标慢。此外，如果患者矢状面排列未能显著改善，则术后功能可能持续受损且预后不良。
