骨质疏松性椎体压缩骨折在退变性脊柱侧凸的分布及危险因素

 目的 总结骨质疏松性椎体压缩骨折在退变性脊柱侧凸中分布的规律性，分析退变性脊柱侧凸患者发生椎 体压缩骨折的危险因素。方法 回顾性分析2004年7月至2012年7月治疗136例退变性脊柱侧凸患者资料，根据术前是 否发生骨质疏松性椎体压缩骨折分为骨折组和无骨折组。骨折组34例，男9例，女25例；年龄(71.7±1.7)岁。无骨折组 102例，男23例，女79例；年龄(63.3±6.7)岁。采用视觉模拟评分(visual analogue scale, VAS)评估胸背部疼痛程度，采 用双能X线骨密度仪测定骨密度T值，测量侧凸Cobb角，观察侧凸范围内骨桥发生情况。采用二分类Logistic逐步回归分析方 法筛选出骨折发生的危险因素。结果 骨折组发生T₁₁骨折3例，T₁₂骨折12例，L₁骨折15例 ，T₁₂及L₁两个椎体骨折4例。 无骨折组平均年龄低于骨折组(t=17.20，P<0.001)，两组的性别组成并无差异(χ²=0.218，P=0.641)，胸背部 疼痛的VAS评分小于骨折组(t=9.30，P< 0.001)，侧凸Cobb角与骨折组相比无差异(t=1.84，P=0.08)，骨质疏松的严重程度 低于骨折组(t=5.63，P<0.001)，骨桥发生率低于骨折组(χ²=12.333，P< 0.001)。Logistic回归分析显示外伤 史(OR=1.36；95%CI，1.09～2.11)、骨桥形成(OR=3.31；95%CI，2.10～5.38)、骨质疏松(OR=2.45；95%CI，1.58～4.36) 会增加退变性脊柱侧凸患者发生骨质疏松性椎体压缩骨折的机会。结论 在退变性脊柱侧凸患者中，骨质疏松性椎体压缩骨折好 发于胸腰段椎体，外伤 史、骨质疏松以及侧凸范围内骨桥形成是骨折发生的危险因素。

Prevalence of osteoporotic vertebral compression fracture in degenerative scoliosis and its features

Objective To explore the prevalence of osteoporotic vertebral compression fracture in degenerative scoliosis and its risk factors. Methods One hundred and thirty?six cases of degenerative scoliosis were retrospectively reviewed from July 2004 to July 2012. According to the occurrence of vertebral compressive fractures, patients were divided into two groups: the case group (fracture) and control group (non?fracture). There were 34 patients with an average age of 71.7 years in case group and 102 patients with an average age of 63.3 years in control group. We used visual analogue scale (VAS) to assess the back pain, and measured Cobb angle to evaluate the severity of scoliosis. Bone mineral density (BMD) and osteophyte were also analyzed. Logistic analysis was used to explore the risk factors of fracture. Results In case group, there were T₁₁ vertebral fracture in 3 cases, T₁₂ vertebral fracture in 12, L₁ vertebral fracture in 15, and both T₁₂ and L₁ vertebral fracture in 4. The average age of case group was higher (t=17.20, P< 0.001) while VAS score was higher than control group (t=9.30, P< 0.001). There was no statistical difference in sex (χ²=0.218, P=0.641) or Cobb angle (t=1.84, P=0.08) between two groups. Osteoporosis was less severe (t=5.63, P< 0.001), and lower incidence of osteophyte was found in control group (χ²=12.333，P< 0.001). Logistic analysis showed that trauma history, osteoporosis and osteophyte formation were risk factors. Injury (OR=1.36; 95%CI, 1.09-2.11), bony bridge (OR=3.31; 95%CI, 2.10-5.38) and osteoporosis (OR=2.45; 95%CI, 1.58-4.36) may increase risk of fracture. Conclusion Osteoporotic vertebral compression fracture usually occur in thoraco?lumbar region in patients with degenerative scoliosis. Trauma history, osteoporosis and bony bridge are risk factors of osteoporotic vertebral compression fracture