骨质疏松性椎体压缩骨折保守治疗失败的危险因素分析  

Risk Factors for Conservative Treatment Failure in Osteoporotic Vertebral Compression Fracture

作　　者：徐晨 董亮[2] 冀家琛 万清明 韩进 黄小强 Xu Chen;Dong Liang;Ji Jiachen;Wan Qingming;Han Jin;Huang Xiaoqiang(Xi’an Medical University,Xi’an 710068,China;Department of Spine Surgery,Affiliated Honghui Hospital of Xi’anJiaotong University,Xi’an 710054,China;Department of Orthopaedics,Xi’an Fifth Hospital,Xi’an 710082,China)

机构地区：[1]西安医学院,陕西西安710068 [2]西安交通大学附属红会医院脊柱外科,陕西西安710054 [3]西安市第五医院骨科,陕西西安710082

出　　处：《实用骨科杂志》2024年第1期14-17,共4页Journal of Practical Orthopaedics

基　　金：陕西省重点研发基金项目(2019SF-192);陕西省自然科学基础研究计划(2022JM-546)。

摘　　要：目的探讨骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)保守治疗失败的危险因素。方法回顾性分析2019年1月至2021年12月因OVCF在西安交通大学附属红会医院接受保守治疗的150例患者资料。正规保守治疗3周后疼痛视觉模拟评分(visual analogue scale,VAS)≥4分定义疼痛缓解不佳,根据疼痛缓解程度将患者分为保守治疗有效组和无效组。保守治疗有效组92例,男31例,女61例;年龄60~84岁,平均(69.5±5.3)岁;保守治疗无效组58例,男17例,女41例;年龄62~94岁,平均(74.9±6.5)岁。记录两组基本人口学资料(性别、年龄、身体质量指数)、基础疾病史(糖尿病、高血压、抑郁症)、骨密度(bone mineral density,BMD)、核磁共振T2加权像(MRI-T2WI)矢状位的局部高信号或弥漫性低信号改变、骨折动态活动度。采用单因素分析法分析上述指标与保守治疗失败的相关性,再通过多因素Logistic回归分析确定保守治疗失败的独立危险因素。结果接受保守治疗3周的150例患者中58例(38.7%)疼痛缓解不佳并明显影响基本的日常生活和活动。单因素分析结果显示,患者年龄、BMD、超重、MRI-T2WI局部高信号或弥漫性低信号改变、骨折动态活动度与保守治疗失败有一定的相关性(P<0.05)。多因素Logistic回归分析结果表明,年龄(OR=1.133,P=0.003)、BMD(OR=5.297,P=0.018)、超重(OR=3.267,P=0.006)、MRI-T2WI局部高信号或弥漫性低信号改变(OR=3.868,P=0.003)、骨折动态活动度(OR=3.623,P=0.007)和合并抑郁症(OR=3.552,P=0.047)是影响保守治疗结果的独立危险因素。受试者工作特征曲线分析显示预测保守治疗失败患者年龄和BMD的最佳截断值分别为72.5岁和-3.3。结论OVCF患者保守治疗失败率较高,高龄、低BMD、超重、MRI-T2WI局部高信号或弥漫性低信号改变、存在骨折动态活动度和合并抑郁症是保守治疗失败的独立危险因素。患者年龄>72.5岁或BMD<-3Objective To identify risk factors for failure of conservative treatment of osteoporotic vertebral compression fracture(OVCF).Methods From January 2019 to December 2021,150 patients who underwent conservative treatment were enrolled in Xi’an Jiaotong University Affiliated Honghui Hospital.Poor pain relief was defined by a visual analogue scale(VAS)≥4 after 3 weeks of regular conservative treatment,and patients were divided into conservative treatment effective and ineffective groups according to the degree of pain relief.The conservative treatment effective group(n=92)had 31 male and 61 female patients.The patients were aged 60 to 84 years,with a mean age of(69.5±5.3)years.The ineffective group(n=58)had 17 male and 41 female patients.The patients aged 62 to 94 years,with a mean age of(74.9±6.5)years.The basic demographic data(gender,age,body mass index),basic disease history(diabetes,hypertension,depression),bone mineral density(BMD),localized high signal or diffuse low signal findings on magnetic resonance imaging(MRI)T 2 weighted(T 2WI),and dynamic fracture mobility were recorded in the two groups.Univariate analysis was used to analyze the correlation between the above parameters and conservative treatment failure.Independent risk factors for failure of conservative treatment were then identified by multivariate logistic regr treatment.Univariate analysis showed that age,BMD,overweight,localized high signal or diffuse low signal findings on MRI-T 2WI,and dynamic fracture mobility were associated with conservative treatment failure(all P<0.05).After multivariate analysis,age(OR=1.133,P=0.003),BMD(OR=5.297,P=0.018),overweight(OR=3.267,P=0.006),dynamic fracture mobility(OR=3.623,P=0.007),localized high signal or diffuse low signal findings on MRI-T 2WI(OR=3.868,P=0.003)and combined with depression(OR=3.552,P=0.047)were independent factors influencing the outcome of conservative treatment.The receiver operating characteristic(ROC)analysis showed that the critical values of age and bone mineral density were 7

关 键 词：骨质疏松性椎体压缩骨折 保守治疗 危险因素 

分 类 号：R683.2[医药卫生—骨科学]