骨质疏松患者胸腰椎再骨折的危险因素分析

【摘要】 目的 通过对骨质疏松性胸腰椎骨折患者的纵向回顾性研究,探讨发生再骨折的高危因素。方法　自 2012 年 3 月至 2014年8 月,我科共治疗骨质疏松性胸腰椎骨折患者200 例,分别采集患者的年龄、性别、椎体高度恢复、Cobb’s角、椎体侧凸畸形、基础椎体骨折数目、骨折病史、手术椎体数、骨水泥量、骨水泥渗漏、骨密度等资料。应用单因素分析模型观察每种因素与椎体再骨折发生的相关性,筛查出可疑的相关因素,然后采用 Logistic 回归分析,得出影响椎体再骨折发生的高危因素。结果 所有患者出院后均获2年以上随访,平均随访时间为2.5年。200例骨质疏松胸腰椎骨折患者,共263 个椎体,35 例 ( 45 个椎体 ) 发生再骨折,再骨折率为17．0％。单因素统计分析发现无再骨折组和再骨折组在年龄、性别、椎体高度恢复、Cobb’s角、椎体侧凸畸形、基础椎体骨折数目、骨折病史、手术椎体数、骨水泥量、骨水泥渗漏以及骨密度方面,当P<0.05时存在统计学意义,当P>0.05时无统计学意义。将单因素分析结果中有统计学意义的各相关因素引入多因素条件Logistic回归分析,OR值>1的变量是危险因素,例如单因素分析中的年龄、椎体高度恢复,OR值<1的变量是保护因素。结论　年龄、椎体高度恢复、Cobb’s角、椎体侧凸畸形、骨水泥渗漏、骨密度是胸腰椎骨折患者再骨折的高危因素。因此,患者应加强自我保护,术者在手术过程中应仔细认真,尽量预防再骨折的发生。     

骨质疏松性骨折椎体成形术后再骨折的治疗

骨质疏松性椎体骨折是由于骨强度下降并遭受轻微创伤或其他原因而导致的骨折.以前骨科治疗这种骨折以止痛、卧床、佩带支具等保守治疗为主,但长期卧床对老年人容易产生深静脉栓塞、肺部及泌尿系感染等并发症.椎体成形术（PVP）能短期内加强椎体的强度、止痛,便于早期下床活动,提高了生活质量,是比较好的治疗方法,但远期可能增加邻近节段椎体骨折的风险.我科从2002年6月至2005年3月,用椎体成形术治疗骨质疏松性骨折256例共306个椎体,收到了良好的治疗效果,但术后2个月～1.5年相邻椎体再次骨折21例,占8.2%,再骨折患者行椎体成形术后也取得良好治疗效果,总结报告如下.     

骨质疏松性骨折后预防再骨折的研究进展

随着全球人口老龄化，骨骼退行性疾病——骨质疏松症的发病率将急剧增加，预计到2020年，每两个50岁以上的美国人中就会有一个可能患有骨质疏松症或是成为骨质疏松症的高危人群。骨质疏松症所产生的最大问题就是骨折，但骨质疏松症又常常是直到骨折才被发现的静悄悄的流行病。在美国每年约有150万人因骨骼疾病而发生骨折，骨质疏松则是导致骨折最常见的原因。骨质疏松性骨折的风险随着年龄增长而升高，特别是绝经后妇女，大约每10个50岁以上的白人女性就有4个可能会发生桡骨远端骨折、椎体骨折及髋部（股骨近端）骨折。将来随着人的寿命增长，所有各种骨折发生率还会提高。     

老年骨质疏松性髋部骨折危险预测

目的综合考虑引起老年人髋部骨折的两个重要因素，设计新预测指标ＢＭＤ／Ｉ，利用多测量区分析提高老年人骨质疏松性髋部骨折危险预测的准确性和可靠性。方法用ＤＥＸＡ测量骨折组和对照组的髋部骨密度，根据有关物理定律推导新预测指标的计算公式。结果利用判别分析得到预测老年人骨质疏松性髋部骨折危险性的判别函数组及预测正确率。讨论多测量区分析较通常采用的单测量区分析预测正确率明显提高，判别函数组可作为计算机辅助诊断的基础，预测结果可供临床医生参考     

骨质疏松危险因素与骨折预防

预防骨质疏松性骨折有宏观和微观两种途径。宏观途径是通过全民宣传教育改善民众行为习惯来防预骨折 ;微观途径是在临床中识别骨质疏松高危个体并给予药物治疗。这里主要就第二种途径进行探讨。1　骨质疏松危险因素进行骨质疏松的危险因素评价可以帮助我们发现可逆转的危险因子 ,如吸烟 ,并予以矫正 ,以及决定是否进行骨密度测量和给予药物治疗。这里主要强调髋骨骨折的危险因素 ,因为其导致最多的残疾和最大的医疗费用 [1] 。对于脊椎骨折 ,比较确定的危险因素只有年龄、脊椎骨折史、非脊椎骨折史、和使用皮质激素类药物。表 1　髋骨骨折的…     

骨质疏松与骨折的关系

骨质疏松症主要危险是脊椎压缩性骨折、髋部骨折和桡骨远端骨折。这种骨质疏松性骨折可加重原发性骨质疏松，易发生再骨折。创伤性骨折，治疗过程中多发生局部或全身性骨质疏松。预防和治疗骨质疏松、骨质疏松性骨折、骨折后骨质疏松及再骨折具有重要意义。本文对骨质疏松与骨折相互影响、病理机理、诊断及预防和治疗作一综述。     

骨质疏松性椎体压缩骨折行PKP术后再骨折的影响因素

目的 观察骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture, OVCF)患者接受PKP术后再骨折的影响因素。方法 选取本院80例行PKP治疗的OVCF患者,按照术后是否再次骨折,分为再次骨折组与未骨折组,收集患者临床资料,采用Logistic回归模型分析术后再骨折的相关影响因素。结果 术后共13例患者(17个椎体)再骨折,发生率16.25%;再次骨折组与未骨折组在年龄、骨折病史、骨水泥渗漏、BMD及椎体高度恢复率等方面的比较有统计学意义(P<0.05);75岁以上、骨折病史、骨水泥渗漏、低BMD、高椎体高度恢复率为术后再次骨折独立危险因素(P<0.05)。结论 OVCF患者PKP术后具有较高的再骨折风险,且以单椎再骨折为主,年龄>75岁、骨折病史、骨水泥渗漏、低BMD、椎体高度恢复率属于其主要的独立危险因素。     

骨质疏松性髋部骨折相关因素临床研究进展

骨质疏松症之所以严重危害老年人,尤其是老年女性身体健康,最重要的原因在于其伴发的骨折。骨质疏松性骨折多发于桡骨远端、脊柱和髋部。其中,髋部骨折的治疗费用、入院率、致残率和病死率远较其它部位的骨质疏松性骨折高。因此,其相关因素的研究,对于正确评价骨折危...     

骨质疏松性椎体压缩骨折术后再发骨折的相关危险因素分析

目的 分析骨质疏松性椎体压缩骨折(OVCF)采用经皮椎体成形术(PVP)治疗后再发骨折的相关危险因素.方法 将296例采用PVP治疗的OVCF患者根据术后是否发生再骨折分成再骨折组(23例)和无再骨折组(273例).采用单因素与多因素logistic回归分析筛选PVP术后再发骨折的相关危险因素.结果 单因素分析结果显示...     

髋部骨折患者的肌少症相关危险因素分析

目的:探讨肌少症在髋部骨折患者中的发生率及相关风险因素。方法:自2013年5月至2017年1月收治髋部骨折患者187例,男99例,女88例;年龄50～95(77.40±10.58)岁。观察分析患者的一般情况、四肢骨骼肌质量指数(ASMI)、脂肪总量、骨矿含量(BMC)、身体质量指数(BMI),握力、术前血维生素D、血白蛋白、美国麻醉医师协会分级评分(ASA)及NMS运动评分。根据握力和ASMI,将患者并分为肌少症组与非肌少症组,采用单因素及多因素分析统计分析。结果:符合肌少症诊断的患者99例(52.9%),与非肌少症组相比,肌少症的发生与高龄、高ASA、低脂肪总量、低骨矿含量、低BMI,低白蛋白、低NMS评分相关,随后进行的二元Logistic回归分析提示高龄(OR=1.804,P=0.048),高ASA评分(OR=3.052,P=0.001),低脂肪总量(OR=0.843,P=0.006),低骨矿含量(OR=0.203,P=0.026)是髋部骨折患者肌少症发生的相关因素。结论:高龄、高ASA评分、低脂肪总量、低骨矿含量可能是髋部骨折患者肌少症的相关危险因素     

Influence of fall related factors and bone strength on fracture risk in the frail elderly

Introduction When subjects are selected on the basis of fall risk alone, therapies for osteoporosis have not been effective. In a prospective study of elderly subjects at high risk of falls, we investigated the influence of bone strength and fall risk on fracture. Methods At baseline we assessed calcaneal bone ultrasound attenuation (BUA) as well as quantitative measures of fall risk in 2005 subjects in residential care. Incident falls and fractures were recorded (median follow-up 705 days). Results A total of 6646 fall events and 375 low trauma fracture events occurred. The fall rate was 214 per 100 person years and the fracture rate 12.1 per 100 person years. 82% of the fractures could be attributed to falls. Although fracture rates increased with decreasing BUA (incidence rate ratio 1.94 for lowest vs. highest BUA tertile, p<0.002), incident falls also affected fracture incidence. Subjects who fell frequently (>3.15 falls/per person year) were 3.35 times more likely to suffer a fracture than those who did not fall. Some fall risk factors such as balance were associated with the lowest fracture risk lowest in the worst performing group. Multivariate analysis revealed higher fall rate, history of previous fracture, lower BUA, lower body weight, cognitive impairment and better balance as significant independent risk factors for fracture. Conclusions In the frail elderly, both skeletal fragility and fall risk including the frequency of exposure to falls are important determinants of fracture risk.     

骨质疏松性椎体压缩性骨折经皮椎体成形术后继发椎体再骨折的相关因素分析

目的 探讨骨质疏松性椎体压缩性骨折（OVCF）采用经皮椎体成形术（PVP）治疗后继发椎体再骨折的相关因素,为预防术后椎体再骨折提供参考依据和理论指导。方法 回顾性分析2019年3月—2020年3月在内蒙古自治区人民医院采用PVP治疗的178例OVCF患者临床资料。收集所有患者性别、年龄、体质量指数（BMI）、骨密度T值、住院时间、手术穿刺路径、骨水泥注入量、骨水泥弥散情况、骨水泥渗漏情况、椎体高度恢复率、术后即刻Cobb角及术后支具佩戴时间,并采用多因素logistic回归分析评价这些因素与术后椎体再骨折的相关性。结果 共29例患者PVP术后发生继发椎体再骨折,再骨折发生率为16.3%(29/178)。再骨折患者与无再骨折患者在年龄、骨水泥注入量、骨水泥渗漏情况、椎体高度恢复率、术后即刻Cobb角及术后支具佩戴时间6个方面差异有统计学意义（P <0.05）。将上述6个因素纳入多因素logistic回归分析,结果显示,骨水泥注入量≥4 mL、骨水泥渗漏、椎体高度恢复率≥10%及术后支具佩戴时间<2个月是术后椎体发生再骨折的危险因素。结论 OVCF患者PVP术后邻近椎体再骨折与...     

骨质疏松性骨折的危险因素及中医证候要素风险评估研究现状

骨质疏松性骨折是骨质疏松症最具破坏性的结局,多个相互作用的危险因素对其发生有一定的影响。人在40岁之后,随着年龄的增长,身体的机能开始逐渐衰退,开始出现如腰酸、背痛、下肢抽筋、乏力等症状,这些症状与肾虚、肝虚、脾虚、血瘀等中医证候要素之间存在一定的关联性,而这些症状的出现可能对骨折的发生有一定的早期提示作用。现有的骨质疏松性骨折风险评估工具多是基于现代医学危险因素开发而成,缺乏骨质疏松性骨折证候学方面的研究内容,在实际应用中存在一定的局限。如果在预测工具中融入中医证候的相关研究内容,建立符合我国人口学特征的骨质疏松性骨折风险评估模型,必将有助于提高风险评估工具对骨质疏松性骨折高危人群的风险评估准确性。     

Compliance with osteoporosis drug therapy and risk of fracture

Introduction Patient compliance with osteoporosis drug therapy is often poor in clinical practice and may be associated with higher risk of fracture. Methods A nested case-control study was undertaken using a US health insurance claims database. The source population included all women aged ≥45 years who began drug therapy for osteoporosis. Cases consisted of those who experienced an osteoporosis-related fracture; they were matched to controls without osteoporosis-related fracture. Compliance with osteoporosis drug treatment was assessed in terms of the number of therapy-days received and medication possession ratio (MPR). Conditional logistic regression was employed to examine the relationship between compliance and fracture risk. Results A total of 453 women with osteoporosis-related fracture were identified and matched to 2,160 controls. Fracture risk was significantly lower for patients with >180 days of therapy [181–360 days: odds ratio (OR) = 0.70, 95% CI = 0.49–0.99; >360 days: OR = 0.65, 95% CI = 0.43–0.99) versus those with ≤30 days. Risk was also lower for patients with MPR ≥90% (OR = 0.70, 95% CI = 0.52–0.93) versus those with MPR <30%. Fracture risk decreased as compliance increased (p_trend < 0.05). Conclusion Among women initiating drug therapy for osteoporosis, better compliance is associated with reduced risk of fracture. Financial Support: Funding for this research was provided by Amgen, Inc., Thousand Oaks, California.     

经皮穿刺椎体后凸成形术治疗骨质疏松性椎体压缩骨折术后发生继发性椎体骨折的危险因素分析

目的 分析骨质疏松性椎体压缩骨折(OVCF)患者行经皮穿刺椎体后凸成形术(PKP)后发生继发性椎体骨折的情况及相关危险因素.方法 对2005年7月至2007年10月行PKP手术治疗的95例OVCF患者(135个椎体),动态监测其术后状态及正常椎体继发骨折与否;对其临床相关参数如性别、骨质疏松原因、骨折部位、矢状面成角、骨水泥注入量、骨水泥椎间隙渗漏、椎体高度恢复、术后支具佩戴、抗骨质疏松治疗及原发骨折类型进行统计学分析,以筛选出发生继发性骨折的相关危险因素.结果 所有患者术后随访10～35个月(平均18个月);其中19例(20.0%)患者25个(18.5%)正常椎体(22个位于手术节段邻近上下椎体)术后发生继发性骨折;其中12例患者的继发骨折在术后3个月内发生.继发性骨质疏松骨折、骨水泥椎间隙渗漏及新鲜椎体骨折是PKP治疗OVCF后发生继发性椎体骨折的危险因素(P＜0.05).结论 OVCF进行PKP手术后部分患者可能在术后早期发生继发性椎体骨折,其发生与骨质疏松原因、术中骨水泥椎间隙渗漏及新鲜椎体骨折相关.     

导致腰椎峡部裂的风险因素研究现状

正腰椎峡部裂是腰椎一侧或两侧椎弓上、下关节突之间的峡部骨质缺损不连续,也称椎弓峡部裂或峡部不连。孔庆奎等[1]研究认为椎弓峡部裂在腰腿疼痛患者中的发生率约为4.17%,国外报道发生率为6%~8%[2-3],而在某些体育运动中发生率高达63%[4]。关于腰椎峡部裂的发生原因学说众多,目前较为统一的观点认为它是在脊柱先天结构异常的基础上,脊柱过度活动或重复屈曲、伸展及旋转等应力刺激引起的应力骨折与疲劳性骨折[5]。但对导     

Analysis on the risk factors of second fracture in osteoporosis-related fractures

Objective: To explore the clinical characteristics and risk factors of refracture in patients suffering from osteoporosis-related fractures as well as effective interventions.Methods: From January 2006 to January 2008, both out-patients and in-patients in our hospital who were over 50 years old and suffered from osteoporosis-related fractures were selected for this research. They were divided into fracture group and refracture group. The refracture rate was followed up for 2 years, during which 11 patients developed refracture, thus were included in the refracture group.Therefore, 273 patients, 225 first-fracture cases, aged (67.7±8.5) years, and 48 refracture cases, aged (72.7-9.5) years,were included in this study. General data including age and sex, fracture types, femoral neck bone mineral density (BMD) T-scores tested by dual-energy X-rays absorptiometry (DEXA), Charlson index, time-frame between two fractures as well as mobility skill assessment were collected and analyzed by single-factor and multivariate statistical methods.Results: Females accounted for 70.2% of the fracture group and 77.1% of the refracture group. The most common refracture type was vertebral fracture for the first time and femoral neck fracture for the second time during the followup. The second fracture happened 3.7 years after the first one on average. The refracture rate was 2.12% within one year, and 4.66% within two years. Risk factors for a second fracture in osteoporotic fracture patients included age (＞75years, HR=1.23, 95%CI 1.18-1.29; ＞85 years, HR=1.68, 95%CI 1.60-1.76), female sex (HR=1.36, 95%CI 1.32-1.40), prior vertebral fractures (HR=1.62, 95%CI 1.01-2.07), prior hip fractures (HR=1.27, 95%CI 0.89-2.42), BMD T-score＜-3.5(HR=1.38, 95%CI 1.17-1.72) and weakened motor skills (HR=1.27,95%CI 1.09-1.40).Conclusions: The risks of second fracture among patients with initial brittle fracture are substantial. There is adequate time between the first and second fractures for interventions to reduce the risks of refracture, especially for the old women with a vertebral or hip fracture. Medication,motor functional rehabilitation and fall-down prevention training are helpful.     

Absolute fracture risk reporting in clinical practice: A physician-centered survey

Summary Non-expert clinical practitioners who had received bone density reports based on 10-year absolute fracture risk were surveyed to determine their response to this new system. Absolute fracture risk reporting was well received and was strongly preferred to traditional T-score-based reporting. Non-specialist physicians were particularly supportive of risk-based bone mineral density (BMD) reporting. Introduction Absolute risk estimation is preferable to risk categorization based upon BMD alone. The objective of this study was to specifically assess the response of non-expert clinical practitioners to this approach. Methods In January 2006, the Province of Manitoba, Canada, started reporting 10-year osteoporotic fracture risks for patients aged 50 years and older based on the hip T-score, gender, age, and multiple clinical risk factors. In May 2006 and October 2006, a brief anonymous survey was sent to all physicians who had requested a BMD test during 2005 and 206 responses were received. Results When asked whether the report contained the information needed to manage patients, the mean score for the absolute fracture risk report was higher than for the T-score-based report (p < 0.0001). When asked whether the report was easy to understand, the mean score for the absolute fracture risk report was again higher than for the T-score-based report (p < 0.0001). Non-specialists gave a higher ranking than specialists to the absolute fracture risk information (p < 0.05). Conclusions Absolute fracture risk reporting is well-received by physicians and is strongly preferred to traditional T-score-based reporting. Non-specialist physicians are particularly supportive of risk-based BMD reporting.