Department of MSK Oncology, University of Calgary, Calgary, Alberta, Canada.
Department of Orthopedics, Ganga Hospital, Coimbatore, India.
World Neurosurg. 2022 Nov;167:e350-e359. doi: 10.1016/j.wneu.2022.08.011. Epub 2022 Aug 10.
Although most osteoporotic vertebral fractures (OVFs) heal conservatively, the most crucial undesirable outcome of conservative treatment is the failure to unite. There is paucity of literature on prevalence and risk factors of pseudarthrosis.
A prospective study involving patients (aged ≥50 years) undergoing conservative treatment of osteoporotic thoracic/lumbar fractures without neurodeficits was performed. Patients were followed for a minimum of 6 months and classified into 3 groups based on fracture healing: group 1, healing without collapse; group 2, healing with collapse; and group 3, pseudarthrosis. An assessment of all clinicoradiologic parameters at the time of injury and at each follow-up was performed and compared among patients belonging to the groups.
A total of 77 patients (90 fractures) were studied. Sixty-six (73.3%), 16 (17.8%), and 28 (8.9%) fractures were classified under groups 1, 2, and 3, respectively. Mean ages in groups 1, 2, and 3 were 67.9 ± 9.1, 70.4 ± 7.6 and 72.3 ± 7.9 years (P = 0.08). Sex distribution was 62:15 (female/male). Seventy-three fractures (81.1%) occurred at the thoracolumbar junction. Stiff spine, ambulatory status, comorbidities, bone mineral density, and injury level were not associated with pseudarthrosis/collapse (P > 0.05). Male sex was associated with pseudarthrosis (P = 0.03). Based on regression analysis, initial vertebral height loss (radiography; P = 0.028), segmental Cobb (radiography; P = 0.019), vertebral comminution (computed tomography; P = 0.032), posterior ligamentous complex injury (magnetic resonance imaging; P = 0.048), and marrow change pattern (T2-weighted magnetic resonance imaging, Kanchiku classification; P = 0.037) were correlated with poorer outcome. Patients with pseudarthrosis had higher visual analog scale score (P = 0.04; final follow-up).
Of OVFs, 8.9% developed pseudarthrosis. Male sex, severity of postinjury vertebral deformation (vertebral loss, kyphosis, comminution, and marrow changes) and presence of posterior ligamentous complex injury are risk factors for pseudarthrosis.
虽然大多数骨质疏松性椎体骨折（OVF）经保守治疗后可愈合，但保守治疗最关键的不良后果是骨折不愈合。目前关于假关节形成的发病率和危险因素的文献很少。
对 77 例（90 处骨折）接受保守治疗的无神经缺损的骨质疏松性胸腰椎骨折患者进行前瞻性研究。所有患者至少随访 6 个月，根据骨折愈合情况分为 3 组：组 1，无塌陷愈合；组 2，愈合伴塌陷；组 3，假关节形成。对所有患者受伤时和每次随访时的临床和影像学参数进行评估，并对属于各组的患者进行比较。
66 例（73.3%）、16 例（17.8%）和 28 例（8.9%）骨折分别归入组 1、组 2 和组 3。组 1、组 2 和组 3 的平均年龄分别为 67.9±9.1 岁、70.4±7.6 岁和 72.3±7.9 岁（P=0.08）。男女比例为 62:15。73 处骨折（81.1%）发生在胸腰椎交界处。僵硬脊柱、活动能力、合并症、骨密度和损伤水平与假关节/塌陷无关（P>0.05）。男性与假关节相关（P=0.03）。基于回归分析，初始椎体高度丢失（X 线；P=0.028）、节段 Cobb 角（X 线；P=0.019）、椎体粉碎（CT；P=0.032）、后纵韧带复合体损伤（MRI；P=0.048）和骨髓改变模式（T2 加权 MRI，Kanchiku 分类；P=0.037）与较差的预后相关。假关节患者的视觉模拟评分（VAS）较高（P=0.04；末次随访时）。
OVF 中，8.9%发生假关节。男性、损伤后椎体变形的严重程度（椎体丢失、后凸畸形、粉碎和骨髓改变）和后纵韧带复合体损伤是假关节形成的危险因素。
