骨质疏松性胸腰椎损伤分类及严重程度评分4分患者的治疗选择

目的探讨骨质疏松性胸腰椎损伤分类及严重程度评分(OTLICS)4分的急性症状性骨质疏松性椎体压缩骨折(OVCF)患者的治疗方法选择。方法采用回顾性病例对照研究分析2016年2月至2018年2月西安交通大学医学部附属红会医院收治的108例急性症状性OVCF患者临床资料,其中男21例,女87例;年龄55~92岁(71.6±5.3)岁]。所有患者OTLICS均为4分。76例采用手术治疗(手术治疗组),32例采用非手术治疗(非手术治疗组)。比较两组患者治疗前、治疗后1周、3个月、6个月及末次随访时的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、健康调查简表(SF-36)评分;比较两组治疗前后伤椎恢复情况(伤椎后凸Cobb角和伤椎前缘高度比)、相邻节段椎体骨折及并发症发生情况。结果患者均获随访12~18个月(13.4±4.2)个月]。术后1周、3个月、6个月手术治疗组VAS(3.5±1.0)分、(2.1±0.6)分、(2.0±0.4)分]低于非手术治疗组(6.4±1.7)分、(5.3±1.5)分、(3.3±0.6)分](P均<0.05),ODI(45.8±10.3)分、(35.3±8.6)分、(26.5±7.1)分]低于非手术治疗组(65.7±12.1)分、(58.3±10.7)分、(45.6±9.3)分](P均<0.05),SF-36评分(82.8±1.4)分、(85.0±1.5)分、(88.0±1.3)分]高于非手术治疗组(80.4±1.3)分、(81.5±1.4)分、(85.6±1.1)分](P均<0.05),而末次随访时VAS、ODI、SF-36评分两组间比较,差异均无统计学意义(P>0.05)。术后3个月、6个月、末次随访时手术治疗组Cobb角(18.3±3.9)°、(17.5±3.0)°、(17.8±1.6)°]小于非手术治疗组(22.4±2.2)°、(22.5±1.7)°、(22.1±1.3)°](P均<0.05),伤椎前缘高度比(75.4±8.6)%、(76.6±8.6)%、(75.2±8.3)%]高于非手术治疗组(63.5±7.6)%、(65.2±7.4)%、(62.8±7.2)%](P均<0.05)。手术治疗组术后发生邻近椎体骨折6例(8%),非手术治疗组发生2例(6%)(P>0.05)。手术治疗组术后出现并发症8例(11%),非手术治疗组出现6例(19%)(P>0.05)。结论对于OTLICS 4分的急性症状性OVCF患者,应及时行手术治疗,可迅速缓解疼痛、矫正畸形、促进功能恢复,从而提高生活质量。

Treatment options for patients with osteoporotic thoracolumbar injury classification and severity score of 4 points after acute symptomatic osteoporotic thoracolumbar compression fracture

Objective To explore the treatment options for patients with osteoporoticthoracolumbar injury classification and severity score(OTLICS)of 4 points following acute symptomaticosteoporotic vertebral compression fracture(OVCF).Methods A retrospective case-control studly wasconducted to analyze the clinical data of 108 patients with acule symptomatic OVCF admitted to Honghui Hospital,Xian Jiaotong University Faculty of Medicine from February 2016 to February 2018.There were2l males and 87 females,aged 55-92 years(71.6±5.3)years].All patients had OTLICS score of4 points.Of all,76 patients were treated operatively(surgery group)and 32 patients were trealted non-operatively(non-surgery group).The visual analogue scale(VAS),Oswestry disability index(ODI)and quality of life score(SF-36)were compared between the two groups before treatment,at l week,3 months,6 months after treatment,and at the last follow-up.The recovery of the injured vertebraebefore and after treatment(Cobb angle of the injured vertebra,relative height of the anterior edge of theinjured vertebrae),adjacent vertebral body fractures,and complications were comparerd between the twogroups.Results All patients were followed up for 12-18 months(13.4±4.2)months].At 1 week,3 months and 6 months after treatment,the VAS in surgery group(3.5±1.0)points,(2.1±0.6)points,(2.0±0.4)points]was better than that in non-surgery group(6.4±1.7)points,(5.3±1.5)points,(3.3±0.6)points](P<0.05),the ODI in surgery group(45.8±10.3)points,(35.3±8.6)points,(26.5±7.l)points]was better than that in non-surgery group(65.7±12.1)points,(58.3±10.7)points,(45.6±9.3)points](P<0.05),the SF-36 in surgery group(82.8±1.4)points,(85.0±1.5)points,(88.0±1.3)points]was better than that in non-surgery group(80.4±1.3)points,(81.5±l.4)points,(85.6±1.l1)points](P<0.05).At the last follow-up,there were no significantdifferences in VAS,ODI and SF-36 between the two groups(P>0.05).At 3 months,6 months and thelast follow-up,the Cobb angle in surgery group(18.3±3.9)°,(17.5±3.0)°,(17.8±1.6)°]wasbetler than that in non-sturgery group(22.4±2.2)°,(22.5±1.7)°,(22.1±1.3)](P<0.05),and the relative height of the anterior edge of the injured vertebra in surgery group(75.4±8.6)%e,(76.6±8.6)%,(75.2±8.3)%]was better than that in non-surgery group(63.5±7.6)%,(65.2±7.4)%,(62.8±7.2)%](P<0.05).The adjacent vertebral fractures occurred in 6 patients(8%)insurgery group,and in 2 patients(6%)in non-surgey group(P>0.05).Postoperative complicationsoccurred in 8 patients(11%)in surgery group,and occurred in 6 patients(19%)in non-surgery group(P>0.05).Conclusion When applying the OTL.ICS scoring system to treat acute symptomatic OVCF,patients with OTLICS score of 4 points should be promptly treated with operatively,which can quickrelieve pain,correct deformities promote functional recovery,and improve quality of life.