单发骨质疏松性椎体压缩骨折的节段分布及临床特征  

Distribution pattern and related factors of single osteoporotic vertebral compression fractures

作　　者：王锋[1] 孙瑞 张聪 张绍东[1] 吴小涛[1] Wang Feng;Sun Rui;Zhang Cong;Zhang Shaodong;Wu Xiaotao(Department of Spinal Surgery,Zhongda Hospital,Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院脊柱外科中心,南京210009

出　　处：《中华骨科杂志》2023年第3期172-178,共7页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金 (81871810)。

摘　　要：目的探讨单发骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)的节段分布及临床特征。方法回顾性分析2016年6月至2020年10月东南大学附属中大医院脊柱外科收治的944例单发OVCF的病历资料,男175例、女769例,年龄(72.1±9.6)岁(范围45~97岁)。总结OVCF节段分布规律,比较高发节段和非高发节段的人口学特征、合并疾病种类、脊柱外伤类型、胸腰背痛主诉时间、椎体楔形变水平和骨密度。结果OVCF呈现以T10为界限的非对称性双峰分布。第一峰区(下胸腰椎)为T11~L5,峰值位于L1,共864例;第二峰区(中上胸椎)为T5~T10,峰值位于T7,共80例。第一峰区的年龄为(71.8±9.6)岁,小于第二峰区的(75.0±9.8)岁(t=2.78,P=0.005)。第一峰区女性占比为81.37%,第二峰区为82.50%,差异无统计学意义(χ^(2)=0.06,P=0.803)。第二峰区主诉胸腰背痛<1周的比例为43.8%,低于第一峰区的60.2%(χ^(2)=11.50,P=0.009)。第二峰区多以隐匿外伤为主(50.0%,40/80),第一峰区多以明显外伤为主(64.1%,554/864),两峰区脊柱外伤类型分布的差异有统计学意义(χ^(2)=60.71,P<0.001)。第二峰区伤椎前后高度比为0.80±0.14,低于第一峰区的0.84±0.13(t=2.48,P=0.013)。第一峰区伤椎前后高度比在胸腰背痛2~周组为(0.80±0.15)、>4周组为(0.77±0.19),低于胸腰背痛<1周组的(0.85±0.11)和1周~组的(0.86±0.14),差异有统计学意义(P<0.05)。第二峰区伤椎前后高度比在胸腰背痛<1周组为(0.78±0.13)、1周~组为(0.83±0.14)、2周~组为(0.84±0.13)、>4周组为(0.78±0.18),差异无统计学意义(F=1.01,P=0.394)。32.4%(306/944)的患者合并高血压、糖尿病、冠心病、脑梗死、慢性阻塞性肺疾病中的1种;第二峰区冠心病合并率(21.3%,17/80)和脑梗死合并率(36.3%,29/80)均高于第一峰区(11.6%,100/864;20.3%,175/864),差异有统计学意义(χ^(2)=6.31,P=0.012;χ^(2)=11.06,P<0.001)。其中371例OVCF(女308例、男63例)腰椎和髋部骨密Objective To identify the anatomical distribution of and factors related to single-segment osteoporotic vertebral compression fractures(OVCF).Methods The radiology and clinical data of 944 patients with single-segment OVCF hospitalized in Zhongda Hospital Southeast University between June 2016 and October 2020 were retrospectively analyzed,including 175 males and 769 females,aged 72.1±9.6 years(range,45-97 years).The anatomical distribution of OVCF was quantified.The demographics,comorbidity profile,spine trauma,back pain duration,vertebral compression degree,and bone mineral density of the OVCF patients in different anatomical segments were summarized and compared.Results Of the 944 single-segment OVCF,864 were located in the lower thoracic and lumbar spine that peaked at L1(Modal-1 group),and 80 were located in the middle and upper thoracic spine(Modal-2 group)that peaked at T7,demonstrating an asymmetric bimodal distribution.The difference in the female/male ratio between the two groups was insignificant(χ^(2)=0.06,P=0.803).Patients in Modal-2 were aged 75.0±9.8 years and on average older than the patients(aged 71.8±9.6 years)in Modal-1(t=2.78,P=0.005).The female patients in Modal-2(aged 75.0±9.6 years)were significantly older than that(aged 71.2±9.3 years)in Modal-1(t=3.17,P=0.002).The ratio of back pain duration for<1 week in Modal-2(43.8%)was lower than that in Modal-1(60.2%),and the ratio of back pain for 1-weeks(28.8%)was significantly higher than that(15.5%)in Modal-1(χ^(2)=11.50,P=0.009).The most frequently reported spine traumas in Modal-2(50.0%)were heavy lifting injury,lumbar sprain,and strenuous cough,which were significantly different from and less apparent than the fall on ground or crush injury to the spine(64.1%)in Modal-1(χ^(2)=60.71,P<0.001).The anterior to posterior height ratio of the fractured vertebrae in Modal-2 was 0.78±0.13,0.83±0.14,0.84±0.13,and 0.78±0.18 in the OVCF patients complaining of back pain for<1 week,1-weeks,2-weeks,and>4 weeks respectively,showing no significan

关 键 词：脊柱骨折 骨质疏松 骨密度 年龄分布 

分 类 号：R687.3[医药卫生—骨科学]