The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures

Introduction Despite vertebral fracture being a significant risk factor for further fracture, vertebral fractures are often unrecognised. A study was therefore conducted to determine the proportion of patients presenting with a non-vertebral fracture who also have an unrecognised vertebral fracture. Methods Prospective study of patients presenting with a non-vertebral fracture in South Glasgow who underwent DXA evaluation with vertebral morphometry (MXA) from DV5/6 to LV4/5. Vertebral deformities (consistent with fracture) were identified by direct visualisation using the Genant semi-quantitative grading scale. Results Data were available for 337 patients presenting with low trauma non-vertebral fracture; 261 were female. Of all patients, 10.4% were aged 50–64 years, 53.2% were aged 65–74 years and 36.2% were aged 75 years or over. According to WHO definitions, 35.0% of patients had normal lumbar spine BMD (T-score −1 or above), 37.4% were osteopenic (T-score −1.1 to −2.4) and 27.6% osteoporotic (T-score −2.5 or lower). Humerus (n=103, 31%), radius–ulna (n=90, 27%) and hand/foot (n=53, 16%) were the most common fractures. For 72% of patients (n=241) the presenting fracture was the first low trauma fracture to come to clinical attention. The overall prevalence of vertebral deformity established by MXA was 25% (n=83); 45% (n=37) of patients with vertebral deformity had deformities of more than one vertebra. Of the patients with vertebral deformity and readable scans for grading, 72.5% (58/80) had deformities of grade 2 or 3. Patients presenting with hip fracture, or spine T-score ≤−2.5, or low BMI, or with more than one prior non-vertebral fracture were all significantly more likely to have evidence of a prevalent vertebral deformity (p<0.05). However, 19.8% of patients with an osteopenic T-score had a vertebral deformity (48% of which were multiple), and 16.1% of patients with a normal T-score had a vertebral deformity (26.3% of which were multiple). Following non-vertebral fracture, some guidelines suggest that anti-resorptive therapy should be reserved for patients with DXA-proven osteoporosis. However, patients who have one or more prior vertebral fractures (prevalent at the time of their non-vertebral fracture) would also become candidates for anti-resorptive therapy—which would have not been the case had their vertebral fracture status not been known. Overall in this study, 8.9% of patients are likely to have had a change in management by virtue of their underlying vertebral deformity status. In other words, 11 patients who present with a non-vertebral fracture would need to undergo vertebral morphometry in order to identify one patient who ought to be managed differently. Conclusions Our results support the recommendation to perform vertebral morphometry in patients who are referred for DXA after experiencing a non-vertebral fracture. Treatment decisions will then better reflect any given patient’s future absolute fracture risk. The 'Number Needed to Screen' if vertebral morphometry is used in this way would be seven to identify one patient with vertebral deformity, and 14 to identify one patient with two or more vertebral deformities. Although carrying out MXA will increase radiation exposure for the patient, this increased exposure is significantly less than would be obtained if X-rays of the dorso-lumbar spine were obtained.     

Role of bone mineral density in predicting morphometric vertebral fractures in patients with HIV infection

Summary

This study investigated the bone of HIV patients both in terms of quantity and quality. It was found that HIV-infected patients did fracture independently of the degree of bone demineralization as in other forms of secondary osteoporosis.

Introduction

We aimed to determine the prevalence of vertebral fractures (VFs) in HIV patients who were screened by bone mineral density (BMD) and to explore possible factors associated with VFs.

Methods

This is a cross-sectional study that included HIV-infected patients recruited in the Clinic of Infectious and Tropical Diseases and that underwent BMD measurement by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and hip (Lunar Prodigy, GE Healthcare). For the assessment of VFs, anteroposterior and lateral X-ray examinations of the thoracic and lumbar spines were performed and were centrally digitized. Logistic regression models were used in the statistical analysis of factors associated with VFs.

Results

One hundred thirty-one consecutive patients with HIV infection (93 M, 38 F, median age 51 years; range, 36-75) underwent BMD measurement: 25.2 % of patients showed normal BMD, while 45 % were osteopenic and 29.7 % osteoporotic. Prevalence of low BMD (osteopenia and osteoporosis) was higher in females as compared to males (90 vs 69 %) with no significant correlation with age and body mass index. VFs occurred more frequently in patients with low BMD as compared to patients with normal BMD (88.5 vs. 11.4 %; p?p?=?0.073). VFs were significantly associated with older age and previous AIDS events.

Conclusions

These results suggest a BMD 相似文献   

High prevalence of simultaneous rib and vertebral fractures in patients with hip fracture

PurposeThe purpose was to evaluate the prevalence and location of simultaneous fracture using bone scans in patients with hip fracture and to determine the risk factors associated with simultaneous fracture.Patients and methodsOne hundred eighty two patients with hip fracture were reviewed for this study. Clinical parameters and bone mineral density (BMD) of the lumbar vertebra and femoral neck were investigated. To identify acute simultaneous fracture, a bone scan was performed at 15.4 ± 4.1 days after hip fracture. The prevalence and location of simultaneous fracture were evaluated, and multivariate logistic regression analysis was performed to determine the risk factors.ResultsSimultaneous fracture was observed in 102 of 182 patients, a prevalence of 56.0%. Rib fracture was the most common type of simultaneous fracture followed by rib with vertebral fracture. The BMD of the lumbar vertebra was significantly lower in patients with simultaneous fracture (p = 0.044) and was identified as an independent risk factor (odds ratio: OR 0.05, 95% confidence interval: CI 0.01–0.57).ConclusionsThe prevalence of simultaneous fracture was relatively high among patients with hip fracture, and BMD was significantly lower in patients with simultaneous fracture than in patients without it. Surgeons should be aware of the possibility of simultaneous fracture in patients with hip fracture.     

The prevalence and risk factors of vertebral fractures in Korean patients with type 2 diabetes

Although type 2 diabetes mellitus (T2DM) has been associated with an increase in fracture risk, there is no data regarding the prevalence of vertebral fractures or its risk factors for patients with T2DM in Korea. In this cross-sectional study, we recruited postmenopausal women with T2DM from 24 tertiary hospital diabetes clinics in Korea. Prevalent vertebral fractures were identified on lateral spinal radiographs of thoracolumbar vertebrae by vertebral morphometry. Demographic and biochemical characteristics related to diabetes were obtained, and bone mineral density of the lumbar spine and femoral neck, which was available in 752 (33.6 %) and 675 (30.1 %) patients, respectively, was also analyzed. Of the 2239 subjects recruited (mean age 63.9 years), a total of 970 (43.3 %) subjects had vertebral fractures. In the bivariate analysis, history of fragility fractures after 50 years of age, microalbuminuria, presence of cardiovascular disease (myocardial infarction, angina, cerebrovascular complications of cardiovascular disease), and presence of osteoporosis at the total hip were significantly associated with the presence of vertebral fractures, after adjusting for age. In the multivariate analysis, the presence of cardiovascular diseases in addition to advancing age and history of fragility fractures was significantly associated with increased odds of vertebral fractures. Vertebral fractures were highly prevalent in postmenopausal women with T2DM in this study conducted in Korea, and the presence of cardiovascular disease, in addition to older age and history of fragility fractures, was significantly associated with the presence of vertebral fractures.     

A comparison between peripheral BMD and central BMD measurements in the prediction of spine fractures in men

Introduction: Most of the research on osteoporosis has been conducted on women. Few studies have compared central and peripheral densitometry and their association with vertebral fractures in men. The present study was designed to compare peripheral bone mineral density (BMD) measurements with central BMD measurements, and to examine their association with radiographic spine fracture in men. Methods: We studied 402 community-dwelling men aged 45–92 years (mean: 70 years) from the Rancho Bernardo Study cohort who attended a clinic visit between 1988 and 1992 when BMD measurements of the midshaft radius, ultradistal wrist, lumbar spine, and total hip were obtained, and who returned for lateral X-rays of the thoracic and lumbar spine an average of 4 years later. Logistic regression, T-scores, and quintiles were used to analyze BMD and its association with vertebral fractures. Results: The prevalence of osteoporosis defined by the National Osteoporosis Foundation criteria (for women) was 14.2% at the spine and 13% at the hip. Because there are no validated definitions of osteoporosis based on the ability to predict fracture risk for peripheral densitometry, the frequency of overlap by bone site was calculated among men in the lowest quintile of each site. Of the 402 men, 82 men (20.3%) had at least two sites with BMD measurements in the lowest quintile. After an average of 4 years, 33 (8.2%) men had at least one radiographic vertebral fracture, and ten (2.5%) men had at least two vertebral fractures. Low BMD at the spine (with and without covariate adjustment) was associated with having one or more vertebral fractures, whether using NOF T-score-defined osteoporosis [Odds ratio (OR): 3.81; confidence interval (CI): 1.52, 9.57] or the lowest quintile versus all others (OR: 2.53; CI: 1.03, 6.19). After age and/or other covariate adjustments, neither BMD at the total hip nor at the peripheral sites was associated with spine fractures using either NOF women-based criteria or male quintiles from this cohort. Conclusion: Although different men had osteoporosis defined by quintiles at different sites, only low BMD at the spine was associated with vertebral fracture.     

Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures.

Fractures and subsequent morbidity determine the impact of established postmenopausal osteoporosis. Health-related quality of life (HRQOL) has become an important outcome criterion in the assessment and follow-up of osteoporotic patients. As part of the baseline measurements of the Multiple Outcomes of Raloxifene Evaluation (MORE) study, HRQOL was assessed in 751 osteoporotic (bone mineral density [BMD] T score > or = -2.5) women from Europe with or without vertebral fractures (VFX). This was done using the quality of life questionnaire of the European Foundation for Osteoporosis (QUALEFFO), Nottingham Health Profile (NHP) and the EQ-5D (former EuroQol). QUALEFFO contains questions in five domains: pain, physical function, social function, general health perception, and mental function. Each domain score and QUALEFFO total scores are expressed on a 100-point scale, with 0 corresponding to the best HRQOL. In comparison with patients without VFX, those with VFX were older (66.2 +/- 5.9 years vs. 68.8 +/- 6.3 years; p < 0.001), had higher prevalence of nonvertebral fractures (25% vs. 36%; p = 0.002), and higher QUALEFFO scores (worse HRQOL; total score, 26 +/- 14 vs. 36 +/- 17; p < 0.001). QUALEFFO scores increased progressively with increasing number of VFX, especially lumbar fractures (p < 0.001). Patients with a single VFX already had a significant increase in QUALEFFO scores (p < 0.05). Similar, though weaker, associations were seen for NHP and EQ-5D scores. This study confirms decreased HRQOL for patients with prevalent VFX. In osteoporotic patients, QUALEFFO scores change in relation to the number of VFX. QUALEFFO is suitable for clinical studies in patients with postmenopausal osteoporosis.     

The prevalence of radiographic vertebral fractures in Mexican men

Summary  

The prevalence of radiographically ascertained vertebral fractures in a random sample of 413 in Mexican men is 9.7% (95% CI 6.85–12.55). Increase of vertebral fracture rises with age from 2.0% in the youngest group (50–59 years) to 21.4% in the oldest group (80 years and over).     

The assessment of vertebral fractures in elderly women with recent hip fractures: the BREAK Study

Summary

This study aimed to evaluate the prevalence of vertebral fractures in elderly women with a recent hip fracture. The burden of vertebral fractures expressed by the Spinal Deformity Index (SDI) is more strictly associated with the trochanteric than the cervical localization of hip fracture and may influence short-term functional outcomes.

Introduction

This study aimed to determine the prevalence and severity of vertebral fractures in elderly women with recent hip fracture and to assess whether the burden of vertebral fractures may be differently associated with trochanteric hip fractures with respect to cervical hip fractures.

Methods

We studied 689 Italian women aged 60 years or over with a recent low trauma hip fracture and for whom an adequate X-ray evaluation of spine was available. All radiographs were examined centrally for the presence of any vertebral deformities and radiological morphometry was performed. The SDI, which integrates both the number and the severity of fractures, was also calculated.

Results

Prevalent vertebral fractures were present in 55.7 % of subjects and 95 women (13.7 %) had at least one severe fracture. The women with trochanteric hip fracture showed higher SDI and higher prevalence of diabetes with respect to those with cervical hip fracture, p?=?0.017 and p?=?0.001, respectively. SDI, surgical menopause, family history of fragility fracture, and type2 diabetes mellitus were independently associated with the risk of trochanteric hip fracture. Moreover, a higher SDI was associated with a higher percentage of post-surgery complications (p?=?0.05) and slower recovery (p?<?0.05).

Conclusions

Our study suggests that the burden of prevalent vertebral fractures is more strictly associated with the trochanteric than the cervical localisation of hip fracture and that elevated values of SDI negatively influence short term functional outcomes in women with hip fracture.     

Visual identification of vertebral fractures in osteoporosis using morphometric X-ray absorptiometry.

Visual identification of vertebral fractures from spinal radiographs (visual XR) makes use of the reader's expertise in ruling out non-fracture deformities or normal variants. Scan images of the spine acquired by DXA may be analyzed quantitatively (morphometric X-ray absorptiometry [quantitative MXA]) or visually (visual MXA). The aims of this study were to compare visual and quantitative MXA with visual XR for the identification of vertebral fractures. Spinal radiographs and MXA scans were acquired at baseline and 1 year in 70 women referred with osteoporosis. These were assessed visually by two expert readers (observer A, a radiologist; observer B, a physician with expertise in osteoporosis) for evidence of prevalent and incident vertebral fractures. Observer C (a radiographer with expertise in vertebral morphometry) performed visual and quantitative assessments of the MXA scans. Visual assessment of spinal radiographs by observer A was used as the gold standard for comparison of methods. Sensitivity for the identification of prevalent fractures by MXA was best for visual MXA by observer A (92%), whereas quantitative MXA had the lowest sensitivity (82%). Specificity was >90% for both visual and quantitative MXA. Kappa scores for agreement for identification of prevalent fractures between visual XR (observer A) and visual MXA (all three observers), and between visual XR and visual MXA performed by reader B were similar (kappa = 0.85-0.87). Agreement with visual XR performed by observer A was slightly lower for quantitative MXA (kappa = 0.77). Interobserver agreement between the two expert readers (observers A and B) was the same for both visual XR and visual MXA (kappa = 0.86). Seven incident vertebral fractures were identified in four patients at follow-up. All four patients were identified by visual MXA, and three patients were identified by quantitative MXA. Observers A and B identified all seven incident fractures by visual MXA, and observer C missed one fracture that was also missed by quantitative MXA. An incident fracture of vertebra T6 was excluded from analysis by quantitative MXA because of poor image quality. We conclude that visual identification of vertebral fractures from MXA scans is superior to quantitative assessment. Used as a screening tool for conventional radiography, this approach could help reduce the radiation dose to the patient in the diagnosis and monitoring of osteoporosis.     

The prevalence and risk factors of vertebral fractures in Korea

We investigated the prevalence and risk factors of vertebral fractures in Korea. In a community-based prospective epidemiology study, 1,155 men and 1,529 women (mean age 59?years, range 43-74) were recruited from Ansung, a rural Korean community. Prevalent vertebral fractures were identified on the lateral spinal radiographs at T11 to L4 using vertebral morphometry. Bone mineral density (BMD) was measured at the lumbar spine, femur neck and total hip. Of the 2,684 subjects, 137 (11.9%) men and 227 (14.8%) women had vertebral fractures and the standardized prevalence for vertebral fractures using the age distribution of Korean population was 8.8% in men and 12.6% in women. In univariate analysis, older age, low hip circumference, low BMD, low income and education levels in both sexes, previous history of fracture in men, high waist-to-hip circumference ratio, postmenopausal status, longer duration since menopause, and higher number of pregnancies and deliveries in women were associated with an increased risk of vertebral fractures. However, after adjusting for age, only low BMD in both sexes and a previous history of fracture in men were significantly associated with an increased risk of vertebral fractures. Vertebral fractures are prevalent in Korea as in other countries. Older age, low BMD and a previous history of fracture are significant risk factors for vertebral fractures.     

Back school for patients with vertebral fractures

Summary Back school is behavior training for the prevention and treatment of back problems arising from faulty body posture and muscular dysfunction. This paper describes the conception and evaluation of a back school program for patients with vertebral fractures. The curriculum includes the provision of detailed information as well as physiotherapy, training in the right way to perform activities of everday life, counseling, relaxation training, and self-monitoring. From October 1987 to June 1990 214 patients with vertebral fractures completed the back school program. The effectiveness of the program was measured by a knowledge test and a behavior test. The results suggest that this back school is an effective addition to conventional concept using physiotherapy exclusively.     

成都地区绝经后妇女脊椎压缩性骨折的患病情况及骨密度变化

目的 本旨在探明绝经后妇女脊椎压缩性骨折的高发部位、患病率随年龄变化的规律以及BMD、BMC等指标的变化规律。方法 以居住在成都地区具有正式户口年龄在50～89岁的健康人群为调查对象．进行随机抽样。对每名受试进行胸腰椎侧位摄片,若楔形指数(椎体前缘／后缘)≤0．8即诊断为压缩性骨折,同时采用DXA对全部受试腰椎正位及髋部的BMD进行测定。计算不同部位及不同年龄段的脊椎压缩性骨折的患病情况。配对后对骨折组和对照组的BMD及其他各项指标进行t检验。结果 胸椎压缩性骨折患病率为8．49%．占脊椎压缩性骨折的76．1%,其中T6、T7、T11、T12的患病率高,共占胸椎压缩性骨折的69．14%;腰椎压缩性骨折的患病率相对较低,占脊椎压缩性骨折的23．9%,主要集中于L1、L2 占腰椎压缩性骨折的93．55%。脊椎压缩性骨折的患病率随年龄的增加而逐渐上升。骨折组腰椎BMD、BMC明显低于对照组(P<0．01)．但二的面积无显性差异(P>0．05)。结论 绝经后妇女随着年龄的增加脊椎压缩性骨折的患病率逐渐升高。胸椎压缩性骨折的患病率高于腰椎．主要发生于T6、T7、T11、T12 腰椎压缩性骨折主要发生于L1、L2。骨折组BMD、BMC均低于对照组,因此可以用BMD、BMC来预测脊柱压缩性骨折发生的危险性。骨密度降低、骨矿含量减少是发生脊椎压缩性骨折的主要危险因素,因此减少骨量的丢失,预防骨质疏松可以有效地防止脊椎压缩性骨折的发生。骨折组与对照组的面积无显性差异．故腰椎正位测定BMD时,以椎体面积变化来预测脊椎压缩性骨折是没有意义的,这提示采用脊柱侧位测定骨密度,则可能会更有意义。     

经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩性骨折

目的 探讨经皮椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩性骨折的临床疗效.方法 30例老年骨质疏松性椎体压缩骨折患者在C臂机引导下行PKP治疗,通过疼痛视觉模拟评分法(VAS),测量Cobb角及术前、术后和末次随访椎体高度等评价疗效.结果 所有手术均顺利完成,疼痛明显缓解,椎体高度无明显丢失,未出现严重骨水泥渗漏,无严重并发症发生;VAS由术前的7.7±1.0下降至术后的2.3±0.7,末次随访的2.4±0.6;Cobb角由术前的(29±5.4)°矫正到术后的(21±3.5)°,末次随访时的(22±3.6)°;椎体高度由术前的(12.9±2.6)mm到术后的(21.5±1.8)mm,末次随访时的(21.3±1.7)mm.术后与术前、末次随访与术前差异均有统计学意义(P<0.05),术后与末次随访差异无统计学意义(P＞0.05).结论 经皮椎体后凸成形术创伤小,安全性高,能有效缓解疼痛,矫正后凸畸形,是一种治疗老年骨质疏松性椎体压缩骨折安全有效的方法.     

骨质疏松性与肿瘤转移性椎体骨折患者代谢指标的比较

目的比较分析骨质疏松性与肿瘤转移性椎体骨折患者相关代谢指标及其关系。方法回顾从2003年01月至2011年06月期间在我院介入血管外科行椎体成形术的146例骨质疏松性椎体骨折患者与111例肿瘤转移性椎体骨折患者的相关代谢指标,运用统计学方法进行统计。统计内容为:性别、年龄、椎体骨折数、手术次数、超敏C-反应蛋白、纤维蛋白原含量、血清总钙、磷、碱性磷酸酶(ALP)、空腹血糖、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白。结果两组患者在性别、年龄、手术次数、血清碱性磷酸酶、甘油三酯、总胆固醇、高密度脂蛋白水平间有统计学差异(P<0.05)。结论骨质疏松性与肿瘤转移性椎体骨折患者在骨代谢及脂代谢方面存在差异,可帮助临床医生及时找出骨折病因,制定合理的治疗方案。     

The discriminatory capacity of BMD measurements by DXA and dual X-ray and laser (DXL) at the calcaneus including clinical risk factors for detecting patients with vertebral fractures

Summary

Osteoporotic fracture risk depends on bone mineral density (BMD) and clinical risk factors (CRF). Five hundred and eighty-eight untreated female and male outpatient subjects were evaluated, 160 with vertebral fractures. BMD was measured both by using calcaneal dual X-ray and laser (DXL) and dual-energy X-ray absorptiometry (DXA), and CRF were evaluated. Detection frequencies for different BMD methods with or without CRF are presented.

Introduction

Osteoporotic fracture risk depends on bone mineral density and clinical risk factors. DXA of the spine/hip is considered a gold standard for BMD assessment, but due to degenerative conditions, particularly among the older population, assessment of BMD at the lumbar spine has been shown to be of limited significance. Portable calcaneal dual X-ray technology and laser can be an easily obtainable alternative.

Methods

Vertebral fractures were evaluated in a baseline analysis of 588 females and males (median age 64.4, range 17.6–93.1 years), comparing BMD measurements by using DXL and DXA and CRF with/without BMD. One hundred and sixty subjects had radiological verified vertebral fractures. Area under receiver-operating characteristic curves (AUROCC) and univariate and multiple logistic regressions were calculated.

Results

AUROCC for detection of vertebral fractures was comparable for DXL at calcaneus and DXA at femoral neck (DXL 0.665 and DXA 0.670). Odds ratio for prevalent vertebral fracture was generally weak for DXA femoral neck (0.613) and DXL (0.521). Univariate logistic regression among CRF without BMD revealed age, prevalent fragility fracture, and body mass index significantly associated with prevalent vertebral fracture (AUROCC?=?0.805). Combining BMD and CRF, a prognostic improvement in case of DXA at femoral neck (AUROCC 0.869, p?=?0.02), DXL at calcaneus (AUROCC 0.869, p?=?0.059), and DXA at total hip (AUROCC 0.861, p?=?0.06) was observed.

Conclusions

DXL was similarly sensitive compared with DXA for identification of subjects with vertebral fragility fractures, and combination of CRF with BMD by DXL or DXA further increased the discriminatory capacity for detection of patients susceptible to vertebral fracture.     

编织囊袋扩张-椎体后凸成形术治疗周壁破损的骨质疏松性椎体压缩骨折

目的评估编织囊袋扩张-椎体后凸成形术治疗周壁破损的骨质疏松性椎体压缩骨折(OVCF)的初步临床效果。方法自2007年12月～2010年4月应用编织囊袋扩张-椎体后凸成形术治疗13例周壁破损的OVCF共15个椎体骨折。随访观察患者的VAS疼痛评分以及影像学改变情况。结果本组获随访3～6个月,平均4.5个月。术后患者疼痛均明显缓解,术后VAS评分、椎体前缘高度和伤椎后凸Cobb角改善显著。未出现骨水泥向椎体外渗漏。结论对于周壁破损的OVCF,编织囊袋扩张-椎体后凸成形术有效避免了骨水泥渗漏、显著缓解疼痛、有效恢复骨折椎体的高度,是一种安全有效的治疗方法。     

Changes in incidence and prevalence of vertebral fractures during 30 years

Summary The age and sex-specific incidence and prevalence of vertebral compression fractures were compared between the 1950s and 1980s in an urban population. In women over 80 years of age the incidence of symptomatic vertebral fractures has increased approximately four times; in elderly men even more. Mainly, low-energy trauma has caused these fractures. Thus, one clinical manifestation of osteoporosis-vertebral fracture-has increased in number, incidence, and prevalence over the last 30 years.     

Distractible vertebral body replacement in patients with malignant vertebral destruction or osteoporotic burst fractures

We studied prospectively the clinical and radiological course of 36 patients with localised spinal instability treated with vertebrectomy. A distractible titanium cage filled with polymethylmethacrylate (PMMA) in combination with transpedicular fixation was used to restore spinal stability. Mean follow-up was 16 (8–55) months. Average correction of the segmental kyphosis was 15.2° (–2–29°). During follow-up, a loss of correction of 0.9° (–2–15°) was seen. Segmental height was increased by 7.6 (0–14) mm on average with a mean loss of 1.6 (0–2) mm. Twenty-one patients without pre-operative neurological deficits were ambulatory without orthosis at discharge. Patients presenting with neurological deficits were unchanged (n=3) or improved (n=12).

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Résumé Nous avons étudié prospectivement lévolution clinique et radiologique de 36 malades avec une instabilité vertébrale localisée traitée par vertebrectomie. Une cage en titane distractable remplie de PMMA en combinaison avec une fixation transpédiculaire a été utilisée pour restaurer la stabilité vertébrale. Le suivi moyen était de 16 mois (8–55). La correction moyenne de la cyphose segmentaire était de 15,2° (–2–29°). Pendant le suivi une perte de correction de 0,9° (–2–15°) a été notée. La hauteur segmentaire a été augmentée à 7,6 (0–14) mm en moyenne avec une perte moyenne de 1,6 (0–2) mm. Vingt et un malades sans déficit neurologique préopératoire pouvaient marcher sans orthèse. Les malades qui présentaient un déficit neurologique étaient inchangés (n=3) ou améliorés (n=12).

     

经皮后凸成形术在治疗骨质疏松性椎体压缩骨折中的应用

[目的]总结经皮后凸成形术在治疗骨质疏松性椎体压缩骨折中的经验和体会.[方法]回顾性分析应用经皮后凸成形术治疗的胸腰椎压缩骨折患者31例46椎,男9例,女22例,年龄61～78岁,平均68岁,椎体骨折位于T7～L3,术前对31例患者均拍摄X线片、CT及MRI,手术采用局部浸润麻醉,经双侧入路球囊扩张注射PMMA骨水泥20例,单侧注射11例,手术前后进行VAS评分、椎体矢状面指数及前后凸Cobb's角测量,进行配对t检验统计分析.[结果]所有患者随访6～30个月,平均18个月,VAS评分由术前平均8.7分降为术后2.5分(P<0.001),终末随访为2.8分,椎体矢状面指数(SI)由术前平均54%恢复至术后88%(P<0.001),终末随访为83%,Cobb's角由术前平均23°恢复为4.8°(P<0.001),终末随访为5.5°,术后93%的患者疼痛明显减轻或消失,无感染及胸肋部刺激性疼痛,无循环及呼吸系统并发症,4例术中发生少量骨水泥渗漏至椎体旁,经术中及术后长期观察,未造成任何神经及血管并发症.[结论]经皮后凸成形术在治疗胸腰椎骨质疏松性骨折中有确切缓解疼痛及恢复椎体高度和形态的作用,是一种理想的治疗方法.     

A back rehabilitation school for patients with vertebral fractures

This paper describes the conception and the evaluation of a back school for patients with vertebral fractures. The school curriculum includes detailed information for the patient as well as physiotherapy, training in the proper way of performing the ordinary activities of the everyday-life, systematic self observation and relaxation training. From October 1987 until July 1989, 136 patients with vertebral fractures have completed the back school program. The effectiveness of the program was evaluated by a knowledge test and by an obstacle course. Both in the pre-post-confrontation as well as in the experimental group-control group comparison we obtained significant differences in the goals. In conclusion, the present results imply that the described back school for patients with vertebral fractures is an efficient addition to conventional programs with physiotherapy only.