胸腰椎骨质疏松性骨折患者流行病学特点研究
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摘要
背景目前,关于胸腰椎骨质疏松性骨折的相关流行病学调查较少,且现有的调查存在数据较少、资料欠完善等不足。因此急需大数据的病例资料统计分析,为胸腰椎骨质疏松性骨折的预防、临床诊断和治疗提供参考依据。目的调查西安交通大学附属红会医院胸腰椎骨质疏松性骨折住院患者的流行病学特点。方法选取2014-01-01至2016-12-31在西安交通大学附属红会医院住院的胸腰椎骨质疏松性骨折患者4 083例,按照年龄分为<60岁组(339例)、60～69岁组(1 850例)、70～79岁组(1 421例)、80～89岁组(441例)、≥90岁组(32例),依据治疗方式分为微创手术治疗组(3 911例)和保守治疗组(172例)。收集患者的一般情况、骨折情况、治疗情况等资料,测定骨密度T值,采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)进行评价。结果男性以70～79岁高发,女性以60～69岁高发,各组女性均多于男性,<60岁组男女比例最大;平均骨密度T值为(-3.2±1.2)SD,骨密度<-3.5 SD者945例(23.14%)。3 751例患者伴至少1种合并症,最常见的合并症为心血管疾病3 278例(80.28%)、糖尿病645例(15.80%)、脑卒中后遗症529例(12.96%)。高能量损伤245例(6.00%),低能量损伤3 838例(94.00%),低能量损伤是主要致伤因素。共4 953个椎体发生骨折,胸腰椎骨折节段大致呈单峰分布,L_1所占比例最高为29.09%(1 441/4 953);胸腰段(T_(11)～L_2)为多发节段,占77.06%(3 817/4 953);腰椎骨折所占比例为53.46%(2 648/4 953),高于胸椎骨折的46.54%(2 305/4 953)。手术患者无脊髓、神经和血管损伤,共79个椎体发生骨水泥渗漏,均无临床症状。微创手术治疗组治疗3个月后骨密度T值大于保守治疗组,VAS、ODI均低于保守治疗组,下肢深静脉血栓、肺部感染发生率均低于保守治疗组,卧床时间短于保守治疗组(P<0.05)。结论胸腰椎骨质疏松性骨折女性多于男性,骨折原因主要为低能量损伤,骨折部位以胸腰段最为多见,且腰椎多于胸椎,椎体成形术或椎体后凸成形术是主要的治疗手段。
Background At present,the epidemiological data on osteoporotic fractures of thoracolumbar spine is insufficient. Therefore,the statistical analysis of big data is urgently needed to provide reference for prevention,clinical diagnosis and treatment of thoracolumbar osteoporotic fracture. Objective To analyze the epidemiological characteristics of inpatients with thoracolumbar osteoporotic fracture in Honghui Hospital,Xi'an Jiaotong University.Methods A total of 4 083 patients with thoracolumbar osteoporotic fracture hospitalized in Honghui Hospital,Xi'an Jiaotong University were included in this study from January 1 st 2014 to December 31 st 2016.According to age,they were divided into below 60 group(339 cases),60-69 group(1 850 cases),70-79 group(1 421 cases),80-89 group(441 cases),and over 90 group(32 cases).According to treatment method,patients were divided into minimally invasive surgery group(3 911 cases) and conventional treatment group(172 cases).Patients' general condition,fracture status and treatment were collected,and T value of bone density and Visual Analogue Scale(VAS) and Oswestry Dysfunction Index(ODI) were evaluated.Results Male patients with the highest incidence of osteoporotic fracture were in the 70-79 group,and females in the 60-69 group.The incidence among female patients in each group was higher than that in male patients.The greatest incidence difference of osteoporosis fracture between males and females was in below 60 group.The average bone mineral density(T value) of all patients was(-3.2±1.2) SD,including 945 patients(23.14%) with bone density less than-3.5 SD.3 751 patients had at least 1 complication,the most common is cardiovascular diseases(3 278 cases,80.28%),diabetes(645 cases,15.80%),stroke sequelae(529 cases,12.96%).A total of 245 subjects(6.00%) had high-energy injuries and 3 838 subjects(94.00%) had low-energy injuries.The main cause of fracture is low energy injury.Fractures occurred in 4 953 vertebral bodies.Thoracolumbar fracture segment were unimodal,with the highest proportion at L_1(29.09%);the highest incidence of fracture occurred in thoracolumbar segment(T_(11)～L_2),accounting for 77.06%(3 817/4 953) of all vertebrae fracture.Lumbar fracture accounted for 53.46%(2 648/4 953),which was higher than thoracic fracture of 46.54%(2 305/4 953).There were no spinal cord,nerve and vascular injuries in patients undergone surgeries.Seventy-nine patients had cement leakage but no clinical symptoms.After 3 months of treatment,the T value in the minimally invasive surgery group was higher than that of conventional treatment group;VAS and ODI were lower than those of conventional treatment group;the incidence of deep vein thrombosis and lung infection was lower than that of conventional treatment group and bed time was shorter than that of conventional group(P<0.05).Conclusion The incidence of osteoporotic fracture in thoracolumbar spine is higher in female patients than that in males.The main cause of fracture is low energy injury,and mostly occurs in thoracolumbar region.Lumbar vertebrae fracture is more common than thoracic vertebrae fracture.Vertebroplasty or kyphoplasty is the main treatment.
Background At present,the epidemiological data on osteoporotic fractures of thoracolumbar spine is insufficient. Therefore,the statistical analysis of big data is urgently needed to provide reference for prevention,clinical diagnosis and treatment of thoracolumbar osteoporotic fracture. Objective To analyze the epidemiological characteristics of inpatients with thoracolumbar osteoporotic fracture in Honghui Hospital,Xi'an Jiaotong University.Methods A total of 4 083 patients with thoracolumbar osteoporotic fracture hospitalized in Honghui Hospital,Xi'an Jiaotong University were included in this study from January 1 st 2014 to December 31 st 2016.According to age,they were divided into below 60 group(339 cases),60-69 group(1 850 cases),70-79 group(1 421 cases),80-89 group(441 cases),and over 90 group(32 cases).According to treatment method,patients were divided into minimally invasive surgery group(3 911 cases) and conventional treatment group(172 cases).Patients' general condition,fracture status and treatment were collected,and T value of bone density and Visual Analogue Scale(VAS) and Oswestry Dysfunction Index(ODI) were evaluated.Results Male patients with the highest incidence of osteoporotic fracture were in the 70-79 group,and females in the 60-69 group.The incidence among female patients in each group was higher than that in male patients.The greatest incidence difference of osteoporosis fracture between males and females was in below 60 group.The average bone mineral density(T value) of all patients was(-3.2±1.2) SD,including 945 patients(23.14%) with bone density less than-3.5 SD.3 751 patients had at least 1 complication,the most common is cardiovascular diseases(3 278 cases,80.28%),diabetes(645 cases,15.80%),stroke sequelae(529 cases,12.96%).A total of 245 subjects(6.00%) had high-energy injuries and 3 838 subjects(94.00%) had low-energy injuries.The main cause of fracture is low energy injury.Fractures occurred in 4 953 vertebral bodies.Thoracolumbar fracture segment were unimodal,with the highest proportion at L_1(29.09%);the highest incidence of fracture occurred in thoracolumbar segment(T_(11)～L_2),accounting for 77.06%(3 817/4 953) of all vertebrae fracture.Lumbar fracture accounted for 53.46%(2 648/4 953),which was higher than thoracic fracture of 46.54%(2 305/4 953).There were no spinal cord,nerve and vascular injuries in patients undergone surgeries.Seventy-nine patients had cement leakage but no clinical symptoms.After 3 months of treatment,the T value in the minimally invasive surgery group was higher than that of conventional treatment group;VAS and ODI were lower than those of conventional treatment group;the incidence of deep vein thrombosis and lung infection was lower than that of conventional treatment group and bed time was shorter than that of conventional group(P<0.05).Conclusion The incidence of osteoporotic fracture in thoracolumbar spine is higher in female patients than that in males.The main cause of fracture is low energy injury,and mostly occurs in thoracolumbar region.Lumbar vertebrae fracture is more common than thoracic vertebrae fracture.Vertebroplasty or kyphoplasty is the main treatment.
引文
[1]OEI L,KOROMANI F,BREDA S J,et al.Osteoporotic vertebral fracture prevalence varies widely between qualitative and quantitative radiological assessment methods:the rotterdam study[J].J Bone Miner Res,2018,33(4):560-568.DOI:10.1002/jbmr.3220.
[2]邱贵兴,裴福兴,胡侦明,等.中国骨质疏松性骨折诊疗指南(骨质疏松性骨折诊断及治疗原则)[J].中华骨与关节外科杂志,2015,8(5):371-374.DOI:10.3969/j.issn.2095-9958.2015.05-001.QIU G X,PEI F X,HU Z M,et al.The Chinese practice guideline for diagnosis and treatment of osteoporotic fracture(the principles for diagnosis and treatment of osteoporotic fracture)[J].Chinese Journal of Bone and Joint Surgery,2015,8(5):371-374.DOI:10.3969/j.issn.2095-9958.2015.05-001.
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[4]程继伟,王振林,刘伟,等.Oswestry功能障碍指数的改良及信度和效度检验[J].中国脊柱脊髓杂志,2017,27(3):235-241.DOI:10.3969/j.issn.1004-406x.2017.03.07.CHENG J W,WANG Z L,LIU W,et al.Improvement of Oswestry disability index and its test of reliability and validity[J].Chinese Journal of Spine and Spinal Cord,2017,27(3):235-241.DOI:10.3969/j.issn.1004-406x.2017.03.07.
[5]PAPAIOANNOU A,WATTS N B,KENDLER D L,et al.Diagnosis and management of vertebral fractures in elderly adults[J].Am J Med,2002,113(3):220-228.
[6]郝定均,贺宝荣,郭华,等.胸腰段骨质疏松性骨折严重程度评分评估及临床应用[J].中国脊柱脊髓杂志,2013,23(8):730-733.DOI:10.3969/j.issn.1004-406X.2013.08.11.HAO D J,HE B R,GUO H,et al.Score assessment system of severity of thoracolumbar osteoporotic fracture and its clinical application[J].Chinese Journal of Spine and Spinal Cord,2013,23(8):730-733.DOI:10.3969/j.issn.1004-406X.2013.08.11.
[7]JAVED F,KHAN S A,AYERS E W,et al.Association of hypertension and bone mineral density in an elderly African American female population[J].J Natl Med Assoc,2012,104(3/4):172-178.
[8]刘嘉鑫,王薇,韩剑锋,等.甲状腺疾病、糖尿病相关骨质疏松的病因研究进展[J].中国骨质疏松杂志,2014,20(2):210-213.LIU J X,WANG W,HAN J F,et al.Research progress of the etiology of thyroid disease and diabetes-related osteoporosis[J].Chinese Journal of Osteoporosis,2014,20(2):210-213.
[9]BENZINGER P,RAPP K,K?NIG H H,et al.Risk of osteoporotic fractures following stroke in older persons[J].Osteoporos Int,2015,26(4):1341-1349.DOI:10.1007/s00198-014-3005-x.
[10]肖建德,阎德文,王大平,等.骨质疏松性骨折的发生机制[M]//肖建德.实用骨质疏松学.北京:科学出版社,2004:127-128.XIAO J D,YAN D W,WANG D P,et al.Mechanism of osteoporotic fracture[M]//XIAO J D.Applied osteoporosis.Beijing:Science Press,2004:127-128.
[11]袁强,王华栋,吕艳伟,等.197例严重骨质疏松胸腰椎骨折患者外伤史和疼痛部位分析[J].山东医药,2014,54(44):5-7.DOI:10.3969/j.issn.1002-266X.2014.44.003.YUAN Q,WANG H D,LYU Y W,et al.The analysis of traumatic history and pain site in patients with severe osteoporosis thoracolumbar fracture,a consecutive series of 197 cases[J].Shandong Medical Journal,2014,54(44):5-7.DOI:10.3969/j.issn.1002-266X.2014.44.003.
[12]HACKENBERG L,HALM H,BULLMANN V,et al.Transforaminal lumbar interbody fusion:a safe technique with satisfactory three to five year results[J].Eur Spine J,2005,14(6):551-558.DOI:10.1007/s00586-004-0830-1.
[13]杨小彬,郝定均,闫亮,等.椎体强化术治疗骨质疏松性胸椎重度压缩骨折[J].中华创伤杂志,2015,31(10):877-881.DOI:10.3760/cma.j.issn.1001-8050.2015.10.004.YANG X B,HAO D J,YAN L,et al.Treatment of severe osteoporotic thoracic compression fracture with vertebral augmentation[J].Chinese Journal of Trauma,2015,31(10):877-881.DOI:10.3760/cma.j.issn.1001-8050.2015.10.004.
[14]YAN L,HE B,GUO H,et al.The prospective self-controlled study of unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty[J].Osteoporos Int,2016,27(5):1849-1855.DOI:10.1007/s00198-015-3430-5.
[15]JESSUP J V,HORNE C,VISHEN R K,et al.Effects of exercise on bone density,balance,and self-efficacy in older women[J].Biol Res Nurs,2003,4(3):171-180.DOI:10.1177/1099800402239628.
[16]YANG E Z,XU J G,HUANG G Z,et al.Percutaneous vertebroplasty versus conservative treatment in aged patients with acute osteoporotic vertebral compression fractures:a prospective randomized controlled clinical study[J].Spine(Phila Pa 1976),2016,41(8):653-660.DOI:10.1097/BRS.0000000000001298.
[17]TANIGAWA N,KARIYA S,KOMEMUSHI A,et al.Percutaneous vertebroplasty for osteoporotic compression fractures:long-term evaluation of the technical and clinical outcomes[J].AJR Am J Roentgenol,2011,196(6):1415-1418.DOI:10.2214/AJR.10.5586.
[18]华俊,刘栋,徐又佳,等.经皮椎体后凸成形术近期疗效及再发骨折率与骨质疏松程度的相关性[J].中华创伤杂志,2015,31(12):1073-1076.DOI:10.3760/cma.j.issn.1001-8050.2015.12.004.HUA J,LIU D,XU Y J,et al.Correlation of short and mediumterm efficacy and refracture rate with osteoporosis severity following pereutaneous kyphoplasty of thoracolumbar fracture[J].Chinese Journal of Trauma,2015,31(12):1073-1076.DOI:10.3760/cma.j.issn.1001-8050.2015.12.004.
[2]邱贵兴,裴福兴,胡侦明,等.中国骨质疏松性骨折诊疗指南(骨质疏松性骨折诊断及治疗原则)[J].中华骨与关节外科杂志,2015,8(5):371-374.DOI:10.3969/j.issn.2095-9958.2015.05-001.QIU G X,PEI F X,HU Z M,et al.The Chinese practice guideline for diagnosis and treatment of osteoporotic fracture(the principles for diagnosis and treatment of osteoporotic fracture)[J].Chinese Journal of Bone and Joint Surgery,2015,8(5):371-374.DOI:10.3969/j.issn.2095-9958.2015.05-001.
[3]XU Z,HAO D,HE L,et al.An assessment system for evaluating the severity of thoracolumbar osteoporotic fracture and its clinical application:a retrospective study of 381 cases[J].Clin Neurol Neurosurg,2015,139:70-75.DOI:10.1016/j.clineuro.2015.09.006.
[4]程继伟,王振林,刘伟,等.Oswestry功能障碍指数的改良及信度和效度检验[J].中国脊柱脊髓杂志,2017,27(3):235-241.DOI:10.3969/j.issn.1004-406x.2017.03.07.CHENG J W,WANG Z L,LIU W,et al.Improvement of Oswestry disability index and its test of reliability and validity[J].Chinese Journal of Spine and Spinal Cord,2017,27(3):235-241.DOI:10.3969/j.issn.1004-406x.2017.03.07.
[5]PAPAIOANNOU A,WATTS N B,KENDLER D L,et al.Diagnosis and management of vertebral fractures in elderly adults[J].Am J Med,2002,113(3):220-228.
[6]郝定均,贺宝荣,郭华,等.胸腰段骨质疏松性骨折严重程度评分评估及临床应用[J].中国脊柱脊髓杂志,2013,23(8):730-733.DOI:10.3969/j.issn.1004-406X.2013.08.11.HAO D J,HE B R,GUO H,et al.Score assessment system of severity of thoracolumbar osteoporotic fracture and its clinical application[J].Chinese Journal of Spine and Spinal Cord,2013,23(8):730-733.DOI:10.3969/j.issn.1004-406X.2013.08.11.
[7]JAVED F,KHAN S A,AYERS E W,et al.Association of hypertension and bone mineral density in an elderly African American female population[J].J Natl Med Assoc,2012,104(3/4):172-178.
[8]刘嘉鑫,王薇,韩剑锋,等.甲状腺疾病、糖尿病相关骨质疏松的病因研究进展[J].中国骨质疏松杂志,2014,20(2):210-213.LIU J X,WANG W,HAN J F,et al.Research progress of the etiology of thyroid disease and diabetes-related osteoporosis[J].Chinese Journal of Osteoporosis,2014,20(2):210-213.
[9]BENZINGER P,RAPP K,K?NIG H H,et al.Risk of osteoporotic fractures following stroke in older persons[J].Osteoporos Int,2015,26(4):1341-1349.DOI:10.1007/s00198-014-3005-x.
[10]肖建德,阎德文,王大平,等.骨质疏松性骨折的发生机制[M]//肖建德.实用骨质疏松学.北京:科学出版社,2004:127-128.XIAO J D,YAN D W,WANG D P,et al.Mechanism of osteoporotic fracture[M]//XIAO J D.Applied osteoporosis.Beijing:Science Press,2004:127-128.
[11]袁强,王华栋,吕艳伟,等.197例严重骨质疏松胸腰椎骨折患者外伤史和疼痛部位分析[J].山东医药,2014,54(44):5-7.DOI:10.3969/j.issn.1002-266X.2014.44.003.YUAN Q,WANG H D,LYU Y W,et al.The analysis of traumatic history and pain site in patients with severe osteoporosis thoracolumbar fracture,a consecutive series of 197 cases[J].Shandong Medical Journal,2014,54(44):5-7.DOI:10.3969/j.issn.1002-266X.2014.44.003.
[12]HACKENBERG L,HALM H,BULLMANN V,et al.Transforaminal lumbar interbody fusion:a safe technique with satisfactory three to five year results[J].Eur Spine J,2005,14(6):551-558.DOI:10.1007/s00586-004-0830-1.
[13]杨小彬,郝定均,闫亮,等.椎体强化术治疗骨质疏松性胸椎重度压缩骨折[J].中华创伤杂志,2015,31(10):877-881.DOI:10.3760/cma.j.issn.1001-8050.2015.10.004.YANG X B,HAO D J,YAN L,et al.Treatment of severe osteoporotic thoracic compression fracture with vertebral augmentation[J].Chinese Journal of Trauma,2015,31(10):877-881.DOI:10.3760/cma.j.issn.1001-8050.2015.10.004.
[14]YAN L,HE B,GUO H,et al.The prospective self-controlled study of unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty[J].Osteoporos Int,2016,27(5):1849-1855.DOI:10.1007/s00198-015-3430-5.
[15]JESSUP J V,HORNE C,VISHEN R K,et al.Effects of exercise on bone density,balance,and self-efficacy in older women[J].Biol Res Nurs,2003,4(3):171-180.DOI:10.1177/1099800402239628.
[16]YANG E Z,XU J G,HUANG G Z,et al.Percutaneous vertebroplasty versus conservative treatment in aged patients with acute osteoporotic vertebral compression fractures:a prospective randomized controlled clinical study[J].Spine(Phila Pa 1976),2016,41(8):653-660.DOI:10.1097/BRS.0000000000001298.
[17]TANIGAWA N,KARIYA S,KOMEMUSHI A,et al.Percutaneous vertebroplasty for osteoporotic compression fractures:long-term evaluation of the technical and clinical outcomes[J].AJR Am J Roentgenol,2011,196(6):1415-1418.DOI:10.2214/AJR.10.5586.
[18]华俊,刘栋,徐又佳,等.经皮椎体后凸成形术近期疗效及再发骨折率与骨质疏松程度的相关性[J].中华创伤杂志,2015,31(12):1073-1076.DOI:10.3760/cma.j.issn.1001-8050.2015.12.004.HUA J,LIU D,XU Y J,et al.Correlation of short and mediumterm efficacy and refracture rate with osteoporosis severity following pereutaneous kyphoplasty of thoracolumbar fracture[J].Chinese Journal of Trauma,2015,31(12):1073-1076.DOI:10.3760/cma.j.issn.1001-8050.2015.12.004.