强直性脊柱炎骨折的危险因素

Factors related to thoracolumbar fractures in ankylosing spondylitis

[目的]探讨强直性脊柱炎(ankylosing spondylitis, AS)患者脊柱骨折的危险因素。[方法] 2014年1月—2018年12月本院收治AS患者80例,依据影像检查确定是否发生胸腰椎骨折将患者分为骨折组与非骨折组,单因素比较两组各项指标。以是否发生骨折的二分变量为因变量,其他因素为自变量的二元多因素逻辑回归,分析骨折的危险因素。[结果] 80例患者中,36例确诊为胸腰椎骨折,占45.00%。单项因素分析,骨折组年龄显著大于非骨折组(P<0.05),骨折组跌倒创伤史比率显著大于非骨折组(P<0.05),骨折组病程显著长于非骨折组(P<0.05),骨折组BASRI评分(Bath ankylosing spondylitis radiology index, BASRI)分数显著大于非骨折组(P<0.05),骨折组腰椎骨密度(bone mineral density, BMD)显著低于非骨折组(P<0.05)。但是,两组间性别构成、BMI、CRP和ESR的差异均无统计学意义(P>0.05)。二元多因素逻辑回归分析表明,外伤(OR=2.338,P=0.014),年龄(OR=1.783,P=0.05),病程(OR=1.421,P=0.011),BASRI评分(OR=2.226,P=0.08)是骨折发生的危险因素;而腰椎BMD (OR=0.247,P=0.003)是骨折发生的保护性因素。[结论]外伤、年龄大、病程长、BASRI评分高是骨折发生的危险因素;而腰椎BMD高是骨折发生的保护性因素。

[Objective] To explore the risk factors of thoracolumbar fracture in ankylosing spondylitis(AS). [Method]From January2014 to December 2018, a total of 80 patients were admitted to our hospital for AS. According to whether thoracolumbar fractures found on radiographs, the patients were divided into fracture group and non-fracture group. An univariate comparison was conducted between the two groups, additionally, a binary multiple logistic regression with the binary variable of whether a fracture occurred as the dependent variable and other factors as independent variables was done to analyze the risk factors related to the fracture. [Results] Among 80 patients, 36 cases were diagnosed as thoracolumbar fractures, accounting for 45.00%. In term of univariate analysis, the fracture group had significantly more advanced age, higher fall trauma ratio, longer disease course and higher BASRI grade, whereas significantly lower lumbar bone mineral density(BMD) than the non-fracture group(P<0.05). However, the differences in gender, BMI, CRP and ESR between the two groups were not statistically significant(P>0.05). As results of binary multivariate logistic regression, the trauma(OR=2.338, P=0.014), age(OR=1.783, P=0.05), course of disease(OR=1.421, P=0.011), BASRI score(OR=2.226, P=0.08) proved risk factors for fracture;while lumbar BMD(OR=0.247, P=0.003) was a protective factor for fracture. [Conclusion] Trauma, advanced age, long course of disease, and high BASRI score are risk factors for fractures, whereas high lumbar spine BMD is a protective factor for fractures.