骨质疏松性椎体压缩骨折的多学科保守治疗

目的 探讨骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fractures，OVCF）多学科保守治疗的临床效果。方法 2015年9月~2016年8月就诊于笔者医院行多学科保守治疗（卧床休息、抗凝、镇痛、抗骨质疏松药物治疗、支具固定、康复理疗）的43例OVCF患者，评价治疗前、治疗后3个月、半年及1年腰背痛视觉模拟量表（visual analog scale，VAS）评分、Oswestry功能障碍指数（Oswestry disability index，ODI）评分、椎体高度、后凸畸形角度、骨密度（bone mineral density，BMD）参数及相关并发症。结果 VAS评分在就诊时、3个月、半年及1年时分别为7.4±1.3分、3.2±1.1分、2.4±1.5分和1.4±1.1分（F=73.1，P=0.000）。ODI评分在就诊时、3个月、半年及1年时分别为64.2±11.0分、31.4±9.9分、25.1±10.5分和15.1±8.5分（F=63.4，P=0.000）。椎体前缘高度在就诊时、3个月、半年及1年时分别为78.6%±4.7%、88.3%±5.7%、89.7%±5.6%和90.7%±6.1%（F=15.8，P=0.000）。椎体中央高度在就诊时、3个月、半年及1年时分别为84.9%±7.8%、93.0%±5.5%、92.2%±6.2%和93.1%±5.1%（F=4.8，P=0.008）。椎体后缘高度在就诊时、3个月、半年及1年时分别为95.6%±3.1%、94.4%±3.3%、95.5%±2.6%和95.4%±2.7%（F=0.384，P=0.765）。Cobb角度在就诊时、3个月、半年及1年时分别为17.90°±8.0°、15.40°±4.7°、16.20°±3.7°和16.60°±3.6°（F=0.326，P=0.806）。BMD值在就诊时、3个月、半年及1年时分别为-4.0±0.7SD，-3.8±0.6SD，-3.3±0.5SD和-3.2±0.7SD （F=8.798，P=0.000）。经过1年保守治疗，VAS （P<0.05）和ODI （P<0.05）评分较治疗前明显下降，椎体前缘和中央高度恢复明显（P<0.05），椎体后缘和后凸角度没有明显改变，BMD值较治疗前显著改善（P<0.05）。治疗期间未发生相关并发症。结论 OVCF多学科保守治疗能够有效缓解疼痛、减少致残率，有效防止疾病进一步进展。

Multidisciplinary Conservative Treatment on Osteoporotic Vertebral Compression Fractures

Objective To investigate the clinical efficacy of multidisciplinary conservative treatment of osteoporotic vertebral compression fractures (OVCF). Methods Forty three patients with OVCF from September 2015 to August 2016 were treated with multidisciplinary conservation(bed rest, anticoagulant, analgesic, anti osteoporosis drugs, brace fixation and rehabilitation therapy) in our hospital.Back pain visual analogue scale (VAS) score, Oswestry disability index (ODI) score, vertebral height, kyphosis angle, bone mineral density (BMD) parameters and related complications were assessed at presentation, 3, 6,and 12 months follow-up. Results The VAS scores were 7.4±1.3, 3.2±1.1, 2.4±1.5 and 1.4±1.1 (F=73.1, P=0.000) at presentation, 3, 6,and 12 months, respectively. The ODI scores were 64.2±11, 31.4±9.9, 25.1±10.5 and 15.1±8.5 (F=63.4, P=0.000) at presentation, 3, 6,and 12 months, respectively. The height of anterior vertebral body was 78.6%±4.7%, 88.3%±5.7%, 89.7%±5.6% and 90.7%±6.1% (F=15.8, P=0.000) at presentation, 3, 6,and 12 months, respectively. The central height of vertebral body was 84.9%±7.8%, 93.0%±5.5%, 92.2%±6.2% and 93.1%±5.1% (F=4.8, P=0.008) at presentation, 3, 6,and 12 months, respectively. The posterior height of the vertebral body was 95.6%±3.1%, 94.4%±3.3%, 95.5%±2.6% and 95.4%±2.7% (F=0384, P=0.765) at presentation, 3, 6,and 12 months, respectively. Cobb angles were 17.9±8.0, 15.4±4.7, 16.2±3.7 and 16.6±3.6 degrees (F=0.326, P=0.806) at presentation, 3, 6,and 12 months, respectively. The BMD value were -4.0±0.7SD and -3.8±0.6SD, -3.3±0.5SD and -3.2±0.7SD (F=8.798, P=0.000) at presentation, 3, 6,and 12 months, respectively. Conclusion OVCF multidisciplinary conservative treatment can effectively relieve pain, reduce disability, and effectively prevent further progress of the disease.