绝经后骨质疏松性椎体骨折经保守治疗后继发椎体塌陷和后凸进展的危险因素

Risk factors for the progression of vertebral body collapse and kyphosis after conservative management of postmenopausal osteoporotic vertebral fractures

目的探讨绝经后骨质疏松性椎体骨折(osteoporotic vertebral fractures,OVF)经保守治疗后继发椎体塌陷和后凸进展的危险因素。方法选择2017年1月~2020年12月在本院接受保守治疗的93例绝经后胸腰椎(T_(10)-L_(2))压缩性骨折患者资料进行回顾性分析,收集指标包括患者年龄、体质量指数(body mass index,BMI)、25-羟基维生素D[25-hydroxyvitamin D,25(OH)D]、日常生活活动能力(activity of daily living,ADL)、椎旁肌横截面积(cross-sectional area,CSA)、椎旁肌脂肪浸润程度、椎体塌陷率(collapse rate,CR)、后凸角、伤椎骨折端不稳(vertebral instability,VI)等,采用Spearman相关性分析和多元线性回归分析观察治疗后6个月时CR和后凸角增加的相关风险因素。结果Spearman相关性分析显示,年龄、25(OH)D、T值与治疗后6个月时CR显著负相关(P<0.05),VI与6个月时CR呈显著正相关(P<0.05)。多元线性回归分析显示,25(OH)D与6个月时CR呈负相关(P<0.05),VI与6个月时CR呈正相关(P<0.05)。Spearman相关性分析显示,6个月时Cobb角与T值、25(OH)D、腰大肌CSA呈显著负相关(P<0.05),与VI呈显著正相关(P<0.05)。多元线性回归分析显示,腰大肌CSA与治疗后6个月时Cobb角呈负相关(P<0.05),VI与治疗后6个月时Cobb角呈正相关(P<0.05)。结论绝经后OVF患者保守治疗6个月时椎体塌陷受基线VI和25(OH)D影响,后凸进展受基线VI和腰大肌CSA影响。

Objective To investigate the risk factors for the progression of vertebral body collapse and kyphosis secondary to conservative management of postmenopausal osteoporotic vertebral fractures(OVF).Methods The data of 93 patients with postmenopausal thoracolumbar(T_(10)-L_(2))compression fractures who received conservative treatment in our hospital from January 2017 to December 2020 were analyzed retrospectively.The collected indexes included patient age,body mass index(BMI),25-hydroxyvitamin D[25(OH)D],activity of daily living(ADL),paravertebral muscle cross-sectional area(CSA),paravertebral muscle fat infiltration,collapse rate(CR),kyphosis angle,vertebral instability(VI),etc.Spearman correlation and multiple linear regression were used to observe the risk factors affecting CR and kyphosis 6 months after operation.Results Spearman correlation showed that age,25(OH)D and T value were significantly negatively correlated with CR 6 months after treatment(P<0.05),and VI was significantly positively correlated with CR 6 months after treatment(P<0.05).Multiple linear regression showed that 25(OH)d was positively correlated with CR 6 months after operation(P<0.05),and VI was negatively correlated with CR 6 months after operation(P<0.05).Spearman correlation showed that Cobb angle was significantly negatively correlated with t value,25(OH)D and psoas major muscle CSA(P<0.05)and positively correlated with VI(P<0.05).Multiple linear regression showed that CSA of psoas major was negatively correlated with Cobb angle 6 months after treatment(P<0.05),and VI was positively correlated with Cobb angle 6 months after treatment(P<0.05).Conclusion The vertebral collapse of postmenopausal OVF patients after 6 months of conservative treatment is affected by baseline VI and 25(OH)d,and the progression of kyphosis is affected by baseline VI and psoas major muscle CSA.