Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
Eur Spine J. 2023 Jul;32(7):2580-2587. doi: 10.1007/s00586-023-07780-8. Epub 2023 May 24.
Thoracic kyphosis, or loss of lumbar lordosis, is often equated with osteoporosis because vertebral fractures are assumed to be a major causative factor, in addition to degeneration related to age. Despite the few studies aiming to measure the natural change in global sagittal alignment (GSA) that occurs with advancing age, the overall effect of conservatively managed osteoporotic vertebral compression fractures (OVCF) on the GSA in the elderly remains poorly understood.
To systematically evaluate the relevant literature regarding the influence of OVCF on the GSA compared to patients of similar age without fractures using the following radiological parameters: Pelvic Incidence (PI), Pelvic Tilt (PT), Lumbar Lordosis (LL), Thoracic Kyphosis (TK), Sagittal Vertical Axis (SVA) and Spino-sacral Angle (SSA).
A systematic review of the English language literature dating up until October 2022, was undertaken utilizing the PRISMA guidelines.
Of a total of 947 articles, 10 studies met the inclusion criteria (4 Level II, 4 level III and 2 level IV evidence) and were subsequently analyzed. Overall, 584 patients (8 studies) of mean age 73.7 years (69.3-77.1) had acute OVCF of one or more vertebra that were managed conservatively. The male to female ratio was 82:412. Five studies mentioned the number of fractured vertebrae, with a total of 393 in 269 patients (average of 1.4 fractured vertebrae per patient). Their pre-operative radiological parameters on standing X-rays showed a mean PI of 54.8°, PT 24°, LL 40.8°, TK 36.5°, PI-LL 14°, SVA 4.8 cm, and SSA 115°. In addition, 437 patients were used as a control group with osteoporosis without fractured vertebrae, (6 studies) with an average age of 72.4 years (67-77.8) and male to female ratio of 96:210 (5 studies). They all had upright X-rays to assess their global sagittal alignments. Radiological parameters showed an average PI of 54.3°, PT 17.3°, LL 43.4°, TK 31.25°, PI-LL 10.95°, SVA 1.27 cm and SSA 125°. A statistical analysis comparing the OVCF group with the control group (4 studies), showed a significant increase in PT of 5.97° (95%CI 2.63, 9.32; P < 0.0005), a significant increase in TK by 8.28° (95%CI 2.15, 14.4; P < 0.008), an increase in PI-LL by 6.72° (95%CI 3.39, 10.04; P < 0.0001), an increase in SVA by 1.35 cm (95%CI 0.88, 1.83; P < 0.00001), and a decrease in SSA by 10.2° (95%CI 10.3, 23.4; P < 0.00001).
Osteoporotic vertebral compression fractures managed conservatively appear to be a significant causate factor of global sagittal imbalance.
胸椎后凸，或腰椎前凸减小，常与骨质疏松症等同，因为人们认为椎体骨折是主要的致病因素，除此之外，与年龄相关的退行性改变也是一个因素。尽管有一些研究旨在测量随着年龄增长而出现的全球矢状面排列（GSA）的自然变化，但保守治疗的骨质疏松性椎体压缩性骨折（OVCF）对老年人 GSA 的整体影响仍知之甚少。
使用以下影像学参数：骨盆入射角（PI）、骨盆倾斜角（PT）、腰椎前凸（LL）、胸椎后凸（TK）、矢状垂直轴（SVA）和脊柱-骶骨角（SSA），系统地评估 OVCF 对 GSA 的影响与具有相似年龄但无骨折的患者相比。
按照 PRISMA 指南对截至 2022 年 10 月的英文文献进行系统综述。
在总共 947 篇文章中，有 10 项研究符合纳入标准（4 项 II 级，4 项 III 级和 2 项 IV 级证据），随后对这些研究进行了分析。总体而言，584 名（8 项研究）年龄 73.7 岁（69.3-77.1）的急性 OVCF 患者有 1 个或多个椎体，采用保守治疗。男女比例为 82:412。5 项研究提到了骨折椎体的数量，269 名患者中有 393 个椎体（平均每位患者有 1.4 个骨折椎体）。他们术前站立位 X 线片的影像学参数显示，PI 平均为 54.8°，PT 24°，LL 40.8°，TK 36.5°，PI-LL 14°，SVA 4.8cm，SSA 115°。此外，437 名患有骨质疏松症但无骨折椎体的患者作为对照组（6 项研究），平均年龄为 72.4 岁（67-77.8），男女比例为 96:210（5 项研究）。他们都拍摄了直立位 X 线片来评估他们的整体矢状面排列。影像学参数显示，PI 平均为 54.3°，PT 17.3°，LL 43.4°，TK 31.25°，PI-LL 10.95°，SVA 1.27cm 和 SSA 125°。将 OVCF 组与对照组（4 项研究）进行统计学分析，结果显示 PT 增加了 5.97°（95%CI 2.63,9.32；P<0.0005），TK 增加了 8.28°（95%CI 2.15,14.4；P<0.008），PI-LL 增加了 6.72°（95%CI 3.39,10.04；P<0.0001），SVA 增加了 1.35cm（95%CI 0.88,1.83；P<0.00001），SSA 减少了 10.2°（95%CI 10.3,23.4；P<0.00001）。
保守治疗的骨质疏松性椎体压缩性骨折似乎是导致全球矢状面失衡的一个重要致病因素。
