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Title: [Epidemiological and clinical characteristics analysis of 681 cases of thoracolumbar osteoporotic vertebral compression fractures].
Author: Chen H, Pan W, Zhang Y, Xing C, Zhang B, Sun B, Zhen Z, Gong L, Xu H.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2022 Jul 15; 36(7):873-880. PubMed ID: 35848185.
Abstract:
OBJECTIVE: To investigate the epidemiological and clinical characteristics of patients with thoracolumbar osteoporotic vertebral compression fracture (OVCF) treated by percutaneous vertebroplasty (PVP). METHODS: The clinical and imaging data of 681 patients with thoracolumbar OVCF treated with PVP between January 2017 and December 2021 were collected. The epidemiological and clinical characteristics of the patients with thoracolumbar OVCF in single center were summarized from the aspects of demographic distribution (mainly including gender, age), fracture characteristic analysis [including pathological segments, bone mineral density, and body mass index (BMI)], and operation related results (including the distribution of unilateral and bilateral puncture and bone cement injection, postoperative effectiveness analysis and refracture). RESULTS: Of the 681 patients, 134 (19.68%) were male and 547 (80.32%) were female, with a male-to-female ratio of 1∶4.08. The age ranged from 53 to 105 years, with an average of 75.3 years. The age group of 60-90 years old had the largest number of patients (91.04%); the high incidence age group of men was 70-90 years old (13.95%), and that of women was 60-80 years old (72.98%). A total of 836 vertebrae were involved, and the morbidity of thoracolumbar vertebrae (T ₁₁-L ₁) was the highest (56.34%, 471/836). The main type of fracture was compression fracture (92.58%, 774/836) and Kümmell disease (7.42%, 62/836). There were 489 cases (71.81%) of osteoporosis, including 66 males and 423 females, with a male-to-female ratio of 1∶6.42. There was significant difference in distribution of bone mineral density between male and female groups ( Z=-5.810, P<0.001). BMI showed 206 cases (30.25%) of underweight, 347 (50.95%) cases of normal, 58 cases (8.52%) of overweight, 42 cases (6.17%) of obese, and 28 cases (4.11%) of extremely obese. The difference in BMI distribution between male and female groups was significant ( Z=-2.220, P=0.026). Of 836 vertebral bodies, 472 (56.46%) were punctured unilaterally and 364 (43.54%) bilaterally. Most of the vertebral bodies (49.88%, 417/836) were injected with 5.0-6.9 mL bone cement, and most of them were distributed in thoracolumbar and lumbar vertebral bodies (T ₁₁-L ₃). The visual analogue scale (VAS) score and Oswestry disability index (ODI) of patients with unilateral puncture and bilateral puncture significantly improved at 6 months after operation ( P<0.001), and also the difference was significant between the two groups in the difference of pre- and post-operation ( P<0.001). There were 628 cases (92.22%) with the first occurrence of OVCF, and 53 cases (7.78%) with two or more times of OVCF, all of which were female patients, and 26 cases (49.06%) occurred in the adjacent segment of the previous PVP operation. CONCLUSION: Female were more than male in OVCF patients. Thoracolumbar vertebral body has the highest morbidity. Patients with low BMI are more likely to have osteoporosis, and patients with high BMI have a higher risk of compression fracture. The amount of bone cement injected through bilateral puncture was greater than that through unilateral puncture. 目的: 探讨采用经皮椎体成形术（percutaneous vertebroplasty，PVP）治疗的胸腰椎骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture，OVCF）患者的流行病学及临床特征。. 方法: 收集2017年1月—2021年12月收治且符合选择标准的681例采用PVP治疗的胸腰椎OVCF患者临床及影像学资料。从人口学分布情况（主要包括性别、年龄）、骨折特征分析［包括病变节段、骨密度和身体质量指数（body mass index，BMI）分布情况］和手术相关结果（包括单、双侧穿刺和骨水泥注入量分布情况，术后疗效分析及再骨折发生情况）方面，总结单中心胸腰椎OVCF流行病学及临床特征。. 结果: 681例患者中，男134例（19.68%），女547例（80.32%），男女比例为1∶4.08。年龄53～105岁，平均75.3岁；60～90岁年龄段患者最多（91.04%）；男性高发年龄段为70～90岁（13.95%），女性为60～80岁（72.98%）。共累及836个椎体，胸腰段椎体（T ₁₁～L ₁）发病率最高，为56.34%（471/836）。骨折类型以压缩性骨折为主，占92.58%（774/836），Kümmell病占7.42%（62/836）。骨质疏松489例（71.81%），其中男66例，女423例，男女比例为1∶6.42。男女组间骨密度分布比较差异有统计学意义（ Z=–5.810， P<0.001）。BMI显示偏瘦206例（30.25%）、正常347例（50.95%）、超重58例（8.52%）、肥胖42例（6.17%）、重度肥胖28例（4.11%）；男女组间比较差异有统计学意义（ Z=–2.220， P=0.026）。836个椎体中，472个（56.46%）行单侧穿刺，364个（43.54%）行双侧穿刺。骨水泥注入量5.0～6.9 mL的椎体最多，占49.88%（417/836），多分布于胸腰段椎体（T ₁₁～L ₃）。单侧穿刺与双侧穿刺患者术后6个月疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）均较术前明显改善（ P<0.001）；组间手术前后差值比较差异均有统计学意义（ P<0.001）。初次发生OVCF者628例（92.22%）；发生2次及以上OVCF者53例（7.78%），均为女性患者，其中26例（49.06%）发生在前次PVP手术节段的相邻节段。. 结论: 胸腰椎OVCF患者女性多于男性；胸腰段椎体发病率最高，低BMI患者更容易出现骨质疏松，高BMI者发生压缩性骨折风险更高；双侧穿刺椎体骨水泥注入量大于单侧穿刺椎体。.

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