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。     

Perspectives: methodologic issues in evaluating risk factors for osteoporotic fractures

Techniques for measuring bone mineral content (BMC) were developed for the purpose of providing an objective and noninvasive indication of bone strength (or lack thereof) and fracture risk, to the extent that strength relates to bone mass. As such, BMC measurements could help to (1) identify those who are most likely to experience nonviolent fractures in the future and who would therefore benefit most from preventive measures, (2) improve their treatment compliance, and (3) monitor the efficacy of treatments intended to reduce bone loss. All these potential uses require that the measurement provide an indication of fracture risk (probability of fractures). During the past 10-15 years there have been conflicting reports regarding the association of reduced BMC with nonviolent fractures. Some authors have criticized the usefulness of BMC measurements, whereas others have questioned the value of one or more techniques. However, the epidemiology of osteoporosis has only recently been subjected to rigorous study. The use of appropriate statistical methods for relating fracture risk to bone mass may be no more widely practiced in osteoporosis epidemiology today than it was for studying risk factors (e.g., blood pressure) in cardiovascular epidemiology during the 1960s. The intent of this article is to explore three areas that may have contributed to controversy in the study of bone mass and fracture occurrence: (1) perspective of the investigators, (2) study design, and (3) analytic methodology. Although the focus of this paper is on bone mass, these considerations are equally applicable to some investigations of other risk factors for osteoporotic fractures (e.g., bone architecture, bone turnover and loss rate, or biochemical markers of bone loss).     

beta-Blocker use, BMD, and fractures in the study of osteoporotic fractures.

A role for osteoblastic beta-adrenoreceptors in bone regulation is suggested by the finding that beta-blockers increase bone mass in mice. We studied the association of beta-blocker use with BMD and fractures in the Study of Osteoporotic Fractures. beta-blocker use and BMD are unrelated in this cohort, and associations with fracture risk are inconsistent. INTRODUCTION: The central nervous system has been shown to regulate bone mass in mice, possibly by way of the beta(2)-adrenoreceptors on osteoblasts. beta-blockers have been shown to increase bone mass in mice. Because these agents are widely used therapeutically, it is possible that they may influence fracture epidemiology in humans, and they are a potential therapy for osteoporosis. MATERIALS AND METHODS: We have studied the association of beta-blocker use with BMD and fracture rates in the Study of Osteoporotic Fractures. beta-blocker use was recorded at the fourth visit, in 8412 women, of whom 1099 were users, and these women were followed for 7 years. RESULTS: Users had significantly higher weight, more thiazide use, more estrogen use, less glucocorticoid use, more statin use, and more hypertension than nonusers, and they smoked less. Total hip BMD at the fourth visit was higher in the beta-blocker users (0.746 versus 0.735 g/cm(2), p = 0.02), but adjustment for weight alone, or together with these other variables, eliminated this difference (p = 0.62). There was no effect of beta-blocker use on loss of hip BMD over a mean follow-up of 4 years (p = 0.48). Os calcis BMD at visit 4 was also higher in those taking beta-blockers (0.385 versus 0.375 g/cm(2), p = 0.005), but weight adjustment eliminated this difference (p = 0.14). The frequencies of hip or any fracture (since age 50) were similar in users and nonusers (p = 0.80 and p = 0.51, respectively). Over a mean follow-up of 7 years, there were 2167 total fractures, including 431 at the wrist and 585 at the hip. Among beta-blocker users, hazards ratios were 0.92 (0.81, 1.05) for any fracture, 0.74 (0.54, 1.01) for wrist fracture, and 0.76 (0.58, 0.99) for hip fracture. Adjustment for weight and other factors previously shown to influence hip fracture incidence in this cohort made little difference to the outcome. When fracture data were analyzed for nonselective and beta(1)-selective agents separately, trends toward fewer fractures were confined to the users of selective beta(1)-blockers. CONCLUSIONS: beta-Blocker use and BMD are unrelated in this cohort, and associations with fracture risk are inconsistent. Therefore, a history of use of these drugs is not useful in assessing fracture risk, nor do they have a role in osteoporosis management at this time. The relationship between beta-blocker use and hip fracture deserves further study.     

Risk factors for newly developed osteoporotic vertebral compression fractures following treatment for osteoporotic vertebral compression fractures

Background context

It has been reported that newly developed osteoporotic vertebral compression fractures (OVCFs) occur at a relatively high frequency after treatment. While there are many reports on possible risk factors, these have not yet been clearly established.

Poverty is a risk factor for osteoporotic fractures

Summary  This study assesses the possible association between poverty and osteoporosis and/or fragility fractures in a population of postmenopausal women. We found that postmenopausal women with low socioeconomic status had lower values of BMD at the lumbar spine, a higher prevalence of densitometric osteoporosis, and a higher prevalence of total and vertebral fractures. Introduction  Some lifestyles are related to the presence of osteoporosis and/or fragility fractures, whereas poverty is related to some lifestyles. Because of this, we studied the possible association of poverty with osteoporosis and fractures. Methods  This was an observational, cross-sectional study performed in the Canary Islands, Spain. Participants consisted of a total of 1,139 ambulatory postmenopausal women aged 50 years or older with no previous osteoporosis diagnosis and who were enrolled in some epidemiological studies. The prevalence of fractures (vertebral and non-vertebral) and the prevalence of osteoporosis (T-score <–2.5 either at the lumbar spine or the femoral neck). A previously validated questionnaire elicited the most important risk factors for osteoporosis: socioeconomic status, defined by the annual income was also assessed by a personal interview. A dorso-lateral X-ray of the spine was performed, and bone mineral density (BMD) was measured by DXA in the lumbar spine (L2–L4) and proximal femur. Results  Compared to women with a medium and high socioeconomic status (n = 665), those who were classified into poverty (annual family income lower than 6,346.80 Euros, in a one-member family, n = 474), were older and heavier and had lower height, lower prevalence of tobacco and alcohol consumption, lower use of HRT and higher use of thiazides. After correcting for age and body mass index (BMI), women in poverty had lower spine BMD values than women with a medium and high socioeconomic status (0.840 g/cm² vs. 0.867 g/cm², p = 0.005), but there were no statistical differences in femoral neck BMD between groups. The prevalence of osteoporosis was also higher in women in poverty [40.6% vs. 35.6%, (OR 1.35, CI 95%: 1.03; 1.76)] after adjusting by age and BMI. Moreover, 37.8% of women in poverty had a history of at least one fragility fracture compared to 27.7% of women not in poverty (OR: 1.45, CI 95%: 1.11; 1.90). The prevalence of vertebral fractures was also higher in women in poverty 24.7% vs. 13.4%, (OR 2.01, CI 95%: 1.44; 2.81). Conclusions  Postmenopausal women with low socioeconomic status had lower values of BMD at the lumbar spine, and a higher prevalence of densitometric osteoporosis, and a higher prevalence of total and vertebral fractures. Because of this, apart from the well known risk factors for osteoporosis, poverty should be taken into account as a possible risk factor for both osteoporosis and fragility fractures, in order to establish sanitary strategies to protect unfavoured postmenopausal women. This study was support by an unrestricted grant of the Canarian Society of Osteoporosis (SOCAOS SL).     

影响骨质疏松性骨折的危险因素和评估方法

骨质疏松性骨折,也被称为脆性骨折或低能量骨折,常常发生于站立或蹲坐位跌倒之后,它不同于机动车的意外事故所致的高能量损伤。骨折直接导致病人行走受限,情绪抑郁,自主性丧失,慢性疼痛。骨密度测定可用于绝大多数的病人,而且已经证实,骨密度降低会增加骨折的风险性。除骨密度外,其他能够增加骨折风险的因素包括:年龄的增加、既往骨折史、跌倒、接受糖皮质激素治疗、家族的髋部骨折史以及当前的吸烟史。本文旨在对骨质疏松骨折的风险评估进行综述。     

Evaluation of easily measured risk factors in the prediction of osteoporotic fractures

Background

Fracture represents the single most important clinical event in patients with osteoporosis, yet remains under-predicted. As few premonitory symptoms for fracture exist, it is of critical importance that physicians effectively and efficiently identify individuals at increased fracture risk.

Methods

Of 3426 postmenopausal women in CANDOO, 40, 158, 99, and 64 women developed a new hip, vertebral, wrist or rib fracture, respectively. Seven easily measured risk factors predictive of fracture in research trials were examined in clinical practice including: age (<65, 65–69, 70–74, 75–79, 80+ years), rising from a chair with arms (yes, no), weight (< 57, ≥ 57kg), maternal history of hip facture (yes, no), prior fracture after age 50 (yes, no), hip T-score (>-1, -1 to >-2.5, ≤-2.5), and current smoking status (yes, no). Multivariable logistic regression analysis was conducted.

Results

The inability to rise from a chair without the use of arms (3.58; 95% CI: 1.17, 10.93) was the most significant risk factor for new hip fracture. Notable risk factors for predicting new vertebral fractures were: low body weight (1.57; 95% CI: 1.04, 2.37), current smoking (1.95; 95% CI: 1.20, 3.18) and age between 75–79 years (1.96; 95% CI: 1.10, 3.51). New wrist fractures were significantly identified by low body weight (1.71, 95% CI: 1.01, 2.90) and prior fracture after 50 years (1.96; 95% CI: 1.19, 3.22). Predictors of new rib fractures include a maternal history of a hip facture (2.89; 95% CI: 1.04, 8.08) and a prior fracture after 50 years (2.16; 95% CI: 1.20, 3.87).

Conclusion

This study has shown that there exists a variety of predictors of future fracture, besides BMD, that can be easily assessed by a physician. The significance of each variable depends on the site of incident fracture. Of greatest interest is that an inability to rise from a chair is perhaps the most readily identifiable significant risk factor for hip fracture and can be easily incorporated into routine clinical practice.     

Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: identification of risk factors

Background context

Percutaneous vertebroplasty (PVP) is a common treatment modality for painful osteoporotic vertebral compression fractures (OVCFs). The complication rate of PVP is low, but cement leakage occurs in up to 90% of the treated levels. Recent evidence suggests that sequelae of cement leakage may be more common and clinically relevant than previously thought. Preoperative appreciation of risk factors would therefore be helpful but has not been thoroughly investigated.

Purpose

Identification of preoperative risk factors for the occurrence of cement leakage in PVP for painful OVCFs.

Study design

Retrospective assessment of risk factors using multivariate analysis.

Patient sample

Eighty-nine patients treated with PVP for 177 painful OVCFs.

Outcome measure

Occurrence of cement leakage.

Methods

The influence of all known risk factors and other parameters potentially affecting the occurrence of cement leakage was retrospectively assessed using multivariate analysis. Patient age, sex, and spinal deformity index; fracture age, level, type, and semiquantitative severity grade (1–4), the presence of an intravertebral cleft and/or cortical disruption on preoperative magnetic resonance imaging (MRI), and the viscosity of bone cement were included. Cement leakage was assessed on direct postoperative computed tomography scanning of the treated levels. In addition to cement leakage in general, three fundamentally different leakage types (cortical, epidural, and anterior venous), with different possible clinical sequelae, were discerned, and their respective risk factors were assessed.

Results

In 130 of 173 (75.1%) treated OVCFs, cement leakage was detected. Leakage incidence was found to increase approximately linear with advancing severity grade. High fracture semiquantitative severity grade (adjusted per grade relative risk [RR], 1.14; 95% confidence interval [CI], 1.05–1.24; p=.002) and low bone cement viscosity (medium vs. low viscosity: adjusted RR, 0.73; 95% CI, 0.61–0.87; p<.001) were strong risk factors for cement leakage in general. For cortical leakage (in 95% intradiscal leakage), the presence of cortical disruption on MRI (adjusted RR, 1.62; 95% CI, 1.16–2.26; p=.004) and an intravertebral cleft on MRI (adjusted RR, 1.43; 95% CI, 1.07–1.77; p=.017) were identified as additional strong risk factors.

Conclusions

High fracture severity grade and low viscosity of polymethylmethacrylate bone cement are general, strong, and independent risk factors for cement leakage. Using MRI assessment, cortical disruption and the presence of an intravertrebral cleft were identified as additional strong risk factors regarding cortical (intradiscal) cement leakage, thereby potentiating anticipation.     

经皮椎体成形术后非手术椎体骨折的相关危险因素

【摘要】 目的：探讨骨质疏松椎体压缩性骨折（OVCFs）经皮椎体成形术（PVP）后非手术椎体骨折的相关危险因素。方法：对2010年3月～2013年3月收治的76例因OVCFs行PVP患者的临床资料进行回顾性分析,包括患者的一般情况、个人史及既往病史、腰椎骨密度、术中骨水泥注入量、病椎压缩程度、骨折椎体个数及节段、骨水泥椎间盘渗漏情况、术后抗骨质疏松治疗情况;收集患者术后第1、3、6、12、18个月来院复诊时测定的骨代谢相关生化指标数据,包括：血钙、磷、降钙素、Ⅰ型胶原氨基端前肽、甲状旁腺激素、25-羟维生素D[25-（OH）D]。将上述指标作为可能相关因素纳入单因素研究,并通过多因素Logistic回归分析得出术后非手术椎体骨折的相关危险因素。结果：76例原发性OVCFs患者共89节椎体骨折,术后共17例患者19个椎体出现压缩性骨折,单因素分析显示术中骨水泥注入量、骨水泥椎间盘渗漏、术后有无抗骨质疏松治疗、血25-（OH）D水平与术后非手术椎体骨折存在显著相关性（P<0．05）,而与患者性别、年龄、体重指数、骨密度值、病椎压缩程度、手术入路等无显著相关性（P>0．05）。多因素分析结果显示骨水泥椎间盘渗漏、术后未进行抗骨质疏松治疗、25-（OH）D水平较低是PVP术后非手术椎体骨折的危险因素（P<0．05）。结论：OCVFs患者PVP术后发生非手术椎体骨折与骨水泥渗漏至椎间盘、术后未抗骨质疏松治疗及低25-（OH）D水平有关。     

骨质疏松性骨折诊断技术与风险预测工具研究进展

目的对骨质疏松性骨折的风险预测工具种类、优缺点进行总结,以期为该病后续临床与科研提供前期工作基础与参考。方法从骨质疏松性骨折常见诊断技术和风险评估工具两个角度,综述近五年骨质疏松性骨折的临床诊断技术和国内外常用风险评估工具。结果诊断技术方面,目前主要有双能X线吸收测定技术、定量超声技术、定量CT技术以及核磁共振技术,大多具有准确、直观等优点,但也有成本高、电离辐射等缺陷;预测工具方面,主要包括骨折风险预测简易工具、国际骨质疏松基金会评估工具、Garvan nomogram评估工具、Q Fracture■算法、亚洲人骨质疏松自我筛选工具、北京友谊医院骨质疏松自我评估工具,其最大优势在于运用简便,但存在灵敏性、特异性、外推性弱等缺陷。此外,考虑了具有中医理论基础的特色症状体征或中医证候要素的风险评估模型,也可为骨质疏松性骨折的早期预防提供必要参考。结论骨质疏松性骨折的诊断技术与风险评估工具日趋增多,但适应我国骨质疏松性骨折高危人群特征的,兼具准确性、实用性的工具并不多见,宜加紧构建适用于我国人群特征的风险预测工具。     

骨质疏松性髋部骨折一年内死亡的危险因素分析

目的 探讨骨质疏松性髋部骨折1年内死亡的独立危险因素。方法 回顾性分析2012年1月至2016年5月我院收治的226例骨质疏松性髋部骨折病人的临床资料,收集病人的性别、年龄、身体质量指数（body mass index, BMI）、基础疾病情况、是否单独居住、日常生活能力评分、骨密度T值、骨折类型、受伤至手术时间、治疗方式、手术方式、麻醉方式、美国麻醉医师协会（American Society of Anesthesiology, ASA）分级以及术前实验室检查指标等临床资料,先后进行单因素分析和多因素Logistic回归分析。结果 1年随访期内,有33例（14.60%）病人死亡,根据病人是否死亡分为死亡组（33例）和生存组（193例）。单因素分析结果显示年龄、性别、基础疾病种类数、慢性肺病、贫血、痴呆、单独居住、日常生活能力评分、骨折至手术时间、治疗方式、全身麻醉、ASA分级以及入院时淋巴细胞、血清白蛋白、血红蛋白、肌酐和骨密度与骨质疏松性髋部骨折1年内死亡相关（P＜0.05）。多因素Logistic回归分析结果表明高龄（OR=2.48,P=0.006）、男性（OR=1.53,P=0.016）、合并基础病种类数≥3类（OR=2.52,P=0.024）、共患慢性肺病（OR=1.74,P=0.017）、共患痴呆（OR=1.21,P=0.025）、日常生活能力评分低（OR=1.61,P=0.014）、ASA分级为Ⅲ~Ⅳ级（OR=1.36,P=0.033）、血清白蛋白水平低（OR=1.30,P=0.041）以及保守治疗方式（OR=1.21,P=0.012）是骨质疏松性髋部骨折1年内死亡的独立危险因素。结论 对于高龄、男性、合并基础疾病类数≥3类、患慢性肺病、痴呆、日常生活能力评分低、ASA分级为Ⅲ~Ⅳ级、血清白蛋白水平低以及保守治疗方式的骨质疏松性髋部骨折病人应予以重视,全面评估病人的身体机能和健康状况,制定合适的治疗方案。     

Vitamin D deficiency as a risk factor for osteoporotic fractures

The evidence on the association between vitamin D deficiency and fracture incidence is contradictory. Therefore, the objective of this study was to examine whether low serum 25-hydroxyvitamin D (25(OH)D) levels are associated with osteoporotic fractures. The study was conducted among 1311 community-dwelling older men and women of the Longitudinal Aging Study Amsterdam (LASA), an ongoing multidisciplinary cohort study. Serum 25(OH)D was determined using a competitive protein binding assay. Fractures were assessed during six years of follow-up. The data were analyzed using Cox proportional hazards model. In total, 11.3% of the persons had a serum 25(OH)D below 10 ng/ml, 48.4% had a value below 20 ng/ml, and 82.4% had a value below 30 ng/ml. Furthermore, 115 persons (8.5%) had one or more osteoporotic fractures. Different cut points of serum 25(OH)D were examined with a cut point of 12 ng/ml giving the best discrimination between persons with and without fractures (17.5% of the persons fell below this cut point). The lowest percentage of fractures (5.6%) was found above 30 ng/ml. Because an interaction effect with age was found (p=0.04), further analyses were conducted separately for persons aged 65-75 years (n=656) and for persons aged 75-89 years (n=664) at baseline. After adjustment for age, sex, season of blood collection, body mass index, number of chronic diseases, serum creatinine, cognition, smoking and alcohol use, serum 25(OH)D below or equal to 12 ng/ml was associated with an increased fracture risk in the youngest age group (HR=3.1; 95% CI: 1.4-6.9), but not in the oldest age group (HR=1.3; 95% CI: 0.7-2.2). For commonly used cut points of serum 25(OH)D (<10 ng/ml, 10-19.9 ng/ml, 20-29.9 ng/ml, > or =30 ng/ml), no statistically significant associations were found after adjustment for confounding. Serum 25(OH)D levels below or equal to 12 ng/ml were associated with an increased fracture risk in persons aged 65-75 years. The relatively low cut point of serum 25(OH)D in our population is possibly caused by high calcium intake in the Netherlands.     

Long-term recreational gymnastics provides a clear benefit in age-related functional decline and bone loss. A prospective 6-year study

Introduction Bone fragility and decreased functional performance are risk factors for osteoporotic fractures. The influence of long-term recreational gymnastics on the maintenance of bone rigidity and physical performance was evaluated.Methods One hundred and seven gymnasts and 110 referents (93% of the original sample) participated in this 6-year prospective study. Analysis of covariance (ANCOVA) was used to estimate the between-group differences and changes by time, and regression analyses to find predictors for changes.Results In both groups agility and leg extensor power decreased by over 3% and 10%, respectively, but the original between-group differences, favoring the gymnasts, persisted. Proximal femur bone mineral content (BMC) decreased approximately 0.5% per year in both groups, and femoral neck section modulus decreased. Trabecular density of the distal tibia declined only marginally, and cortical area of the tibial midshaft remained unchanged, while cortical density decreased about 2% in both groups. After adjustment by age, height, weight, change in weight, and follow-up time, antiresorptive medication and high calcium intake accounted most for the maintenance of bone rigidity.Conclusions In spite of similar rates of decline in bone characteristics and physical performance, the recreational gymnasts’ overall physical condition was comparable to the level that their less active referents had shown approximately 5 years earlier.     

Ten-year risk of osteoporotic fractures in postmenopausal Chinese women according to clinical risk factors and BMD T-scores: a prospective study.

Independent risk factors for osteoporotic fracture were identified for a Southern Chinese postmenopausal population. Clinical risk factor assessment with or without BMD measurement was shown to be an effective predictor of 10-yr risk of osteoporotic fracture and provides a more accessible tool for patient evaluation. INTRODUCTION: Asian-specific data on risk factors for osteoporosis remain sparse. However, risk factor assessment, in addition to BMD measurement, is increasingly recognized as a reliable predictor of absolute osteoporotic fracture risk. The purpose of this prospective study was to determine the specific independent risk factors for osteoporotic fracture and to predict the 10-yr risk of osteoporotic fracture in the postmenopausal Southern Chinese population. MATERIALS AND METHODS: A total of 1435 community-dwelling, postmenopausal, treatment-naive women were recruited. Baseline demographic characteristics and clinical risk factors were obtained, and BMD at the spine and hip was measured. Subjects were followed for outcomes of incident low trauma fracture. Ten-year risk of osteoporotic fracture was predicted from the risk factor assessment and BMD measurement by Cox proportional hazards models. RESULTS: The mean age of subjects was 63.4 +/- 8.3 yr. After 5.0 +/- 2.3 yr (range, 1.0-11.0 yr) of follow-up, 80 nontraumatic new fractures were reported during follow-up. Eight independent clinical risk factors identified at baseline were found to be significant predictors of osteoporotic fracture, with the most important being use of walking aids (RR, 4.2; 95% CI, 2.7-6.7; p < 0.001) and a history of fall (RR, 4.0; 95% CI, 2.5-6.2; p < 0.001). Other predictive factors included being homebound, calcium intake < 400 mg/d, age > 65 yr, history of fracture, and BMI < 19 kg/cm(2). Subjects with three to eight clinical risk factors had a predicted 10-year risk of osteoporotic fracture of 25%, which increased to 30% if they also had total hip BMD T-score 相似文献   

骨质疏松性椎体压缩骨折椎体成形术后非手术椎体再骨折危险因素探讨

骨质疏松性椎体压缩骨折(osteoprosis vertebral compression fracture,OVCF)是老年性及绝经后骨质疏松症患者最常见的严重并发症,骨折患者常有骨性疼痛、椎体高度下降、脊柱后凸畸形等临床表现,严重影响患者生活质量。经皮椎体成形术(percutaneous vertebroplasty,PVP)、经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)及网袋加压椎体成形术(vesselplasty)是治疗OVCF的常用术式,在恢复椎体高度、预防后凸畸形、减轻疼痛症状等方面优势突出。但OVCF患者椎体成形术后存在非手术椎体再发骨折的可能性,在影响手术质量的同时,对患者术后康复、生活质量、经济负担均有较大影响。椎体成形术后非手术椎体再发骨折与骨质疏松进程、初始骨折部位及数量等自身客观因素相关,也与术后椎体高度的过度恢复、骨水泥渗漏、骨水泥过度填充等手术因素密切相关。本文通过查阅近年来关于OVCF患者椎体成形术后非手术椎体再发骨折危险因素及原因文献报道,综述经过统计学方法验证的,具有统计学意义的危险因素,通过患者自身因素、手术因素等方面展开探讨,以期能够为临床降低OVCF患者椎体成形术后再发骨折的发生率提供相关参考。     

骨质疏松性椎体压缩骨折PVP术后相邻椎体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(OVCFs)患者行经皮椎体成形术(PVP)后相邻椎体骨折的相关因素。方法:对2004年3月～2008年6月112例行单节段PVP治疗的OVCFs患者进行回顾性分析。记录患者的年龄、性别、病程、有无外伤、术前椎体压缩程度、骨密度、手术入路(单侧或双侧)、麻醉方式、有无侧凸畸形、骨水泥剂量、骨水泥渗漏至椎间盘等情况。应用单因素和多因素Logistic回归分析研究各因素与PVP术后发生相邻椎体骨折的关系。结果:112例患者中有21例患者术后发生相邻椎体骨折共23个椎体,发生率为18.8%。单因素分析结果显示患者术前椎体压缩程度、骨密度、骨水泥剂量、骨水泥渗漏至椎间盘与术后发生相邻椎体骨折有显著相关性(P0.05),而患者年龄、性别、病程、有无外伤、手术入路、麻醉方式、有无侧凸畸形与术后相邻椎体骨折无显著相关性(P0.05)。多因素分析结果显示患者术前椎体压缩程度较重、骨水泥注射量较大及骨水泥渗漏至椎间盘与术后发生相邻椎体骨折相关(P0.05)。结论:OVCFs患者PVP术后相邻椎体骨折可能与术前椎体压缩程度、骨水泥渗漏至椎间盘、骨水泥注射量等因素相关。     

骨质疏松性椎体压缩骨折PVP术后非手术椎体骨折的相关因素分析

【摘要】　目的：探讨骨质疏松性椎体压缩骨折（OVCFs）经皮椎体成形术（PVP）后非手术椎体骨折的相关因素。方法：2007年1月～2010年3月门诊和病房共收治OVCFs PVP术后非手术椎体骨折患者42例,男8例,女34例,年龄55～82岁,平均67.3岁,均行脊柱X线片及MRI检查,确诊为相邻或非相邻椎体骨折;选取同期随访的PVP术后非手术椎体无骨折患者68例,男17例,女51例,年龄52～75岁,平均60.1岁。应用双能X线吸收法测定腰椎（L2～L4）骨密度值,并记录患者年龄、性别、体重指数、术前是否长期（超过1年）服用糖皮质激素类药物、手术部位（胸椎或腰椎）及单双侧入路等情况,分析引起非手术椎体骨折的相关因素。结果：单因素分析显示两组患者在年龄、骨密度及是否长期服用糖皮质激素方面比较差异有统计学意义（P＜0.05）,在性别、体重指数、手术部位及入路方面比较差异无统计学意义（P＞0.05）。多因素分析显示高龄、骨密度T值≤-2.5SD及长期服用糖皮质激素是导致PVP术后非手术椎体骨折的危险因素,其OR值分别为3.775、5.980、3.401（P＜0.05）。结论：高龄、骨质疏松及服用糖皮质激素药物超过1年是导致OVCFs患者PVP术后非手术椎体骨折的相关因素。     

The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women

Summary BMD and clinical risk factors predict hip and other osteoporotic fractures. The combination of clinical risk factors and BMD provide higher specificity and sensitivity than either alone. Introduction and hypotheses To develop a risk assessment tool based on clinical risk factors (CRFs) with and without BMD. Methods Nine population-based studies were studied in which BMD and CRFs were documented at baseline. Poisson regression models were developed for hip fracture and other osteoporotic fractures, with and without hip BMD. Fracture risk was expressed as gradient of risk (GR, risk ratio/SD change in risk score). Results CRFs alone predicted hip fracture with a GR of 2.1/SD at the age of 50 years and decreased with age. The use of BMD alone provided a higher GR (3.7/SD), and was improved further with the combined use of CRFs and BMD (4.2/SD). For other osteoporotic fractures, the GRs were lower than for hip fracture. The GR with CRFs alone was 1.4/SD at the age of 50 years, similar to that provided by BMD (GR = 1.4/SD) and was not markedly increased by the combination (GR = 1.4/SD). The performance characteristics of clinical risk factors with and without BMD were validated in eleven independent population-based cohorts. Conclusions The models developed provide the basis for the integrated use of validated clinical risk factors in men and women to aid in fracture risk prediction.     

经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折远期并发症的Meta分析

目的:应用Meta分析评价经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折(OVCF)的远期并发症,为临床应用提供依据。方法:计算机检索CNKI、CBM、Pub Med、The Cochrane Library(2017年第2期)、Wiley Online Library、ELSEVIER Science Direct(SDOS)数据库,检索时间均是从建库到2017年2月。收集PKP与保守治疗OVCF的相关随机对照试验(RCT)文献,经X线、CT及MRI确定诊断为胸腰椎压缩骨折;骨密度测量仪测量确定存在胸腰椎骨质疏松(T≤-2.5);年龄≥50岁,病程6个月;术后结局指标至少包括以下指标中的一项:新发椎体骨折、邻近节段椎体骨折、严重并发症、视觉模拟评分。参考Cochrane系统评价手册5.0.1提供的针对随机对照试验的评价标准对纳入文献质量进行评价。结果:共纳入5篇RCT研究,4篇为英文文献,1篇为中文文献,方法学质量评价4篇文献为4分及以上,1篇文献为3分。PKP组共计417例,保守治疗组共计458例。Meta分析结果显示,PKP组治疗后3~6个月视觉模拟评分(VAS)与保守治疗组相比有统计学意义[MD=-0.36,95%CI(-0.65,-0.07),P=0.02];在新发椎体骨折、邻近节段椎体再发骨折、严重并发症三个方面PKP组与保守治疗组无统计学差异。结论:应用PKP治疗OVCF可以降低患者疼痛VAS评分,并且不会提高新发椎体骨折、邻近节段椎体再发骨折、严重并发症的发生风险。