Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture
Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture
复制标题
DOI：
10.1007/s00586-009-1041-6
复制
发表时间：
2009-09-01
影响因子：
2.8
通讯作者：
Takaoka, Kunio
中科院分区：
文献类型：
--
作者：
Hoshino, Masatoshi;Nakamura, Hiroaki;Takaoka, Kunio
本研究的目的是探讨影响骨质疏松性椎体骨折（OVF）后骨愈合不全患者神经功能缺损和顽固性背痛严重程度的因素。OVF术后愈合不足的报告最近有所增加。患者有不同程度的神经功能缺损和背部疼痛。然而，导致这些严重程度的因素仍然未知。本研究共纳入45例OVF术后愈合不全患者。根据平片或CT显示的椎体裂，以及t2加权MRI显示的高强度改变的液体收集，诊断不愈合。进行多因素logistic回归分析，以确定影响患者神经功能缺损和背痛严重程度的因素。年龄、性别、骨折程度、症状发作后持续时间、局部后凸程度、角度不稳程度、骨碎片占比、黄是否突出、相邻节段前纵韧带（OALL）是否骨化被用作解释变量，神经功能缺损的严重程度和背部疼痛被用作反应变量。在多变量分析中，显著影响神经功能缺损严重程度的因素是超过15度的角度不稳定[校正优势比（OR）， 9.24(95%可信区间，CI 1.49-57.2)；P < 0.05]，椎管内骨碎片占比大于42%[校正OR 9.23 (95% CI 1.15-74.1)；P < 0.05]。显著影响背痛严重程度的因素是超过15度的角度不稳定[调整后比值为14.9 (95% CI 2.11-105)；P < 0.01]。另一方面，相邻水平的OALL的存在降低了背痛的程度[调整OR 0.14 (95% CI 0.03-0.76)；P < 0.05]。在本研究中，椎管内明显的角度不稳定和明显的骨碎片后突是影响神经功能缺损的因素。此外，明显的角度不稳定是影响背部疼痛的一个因素。这些发现有助于确定OVF后愈合不足患者的治疗方案。
The purpose of this study was to examine factors affecting the severity of neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture (OVF). Reports of insufficient union following OVF have recently increased. Patients with this lesion have various degrees of neurological deficits and back pain. However, the factors contributing to the severity of these are still unknown. A total of 45 patients with insufficient union following OVF were included in this study. Insufficient union was diagnosed based on the findings of vertebral cleft on plain radiography or CT, as well as fluid collection indicating high-intensity change on T2-weighted MRI. Multivariate logistic regression analysis was performed to determine the factors contributing to the severity of neurological deficits and back pain in the patients. Age, sex, level of fracture, duration after onset of symptoms, degree of local kyphosis, degree of angular instability, ratio of occupation by bony fragments, presence or absence of protrusion of flavum, and presence or absence of ossification of the anterior longitudinal ligament (OALL) in the adjacent level were used as explanatory variables, while severity of neurological deficits and back pain were response variables. On multivariate analysis, factors significantly affecting the severity of neurological deficits were angular instability of more than 15 degrees [adjusted odds ratio (OR), 9.24 (95% confidence interval, CI 1.49-57.2); P < 0.05] and ratio of occupation by bony fragments in the spinal canal of more than 42% [adjusted OR 9.23 (95% CI 1.15-74.1); P < 0.05]. The factor significantly affecting the severity of back pain was angular instability of more than 15 degrees [adjusted OR 14.9 (95% CI 2.11-105); P < 0.01]. On the other hand, presence of OALL in the adjacent level reduced degree of back pain [adjusted OR 0.14 (95% CI 0.03-0.76); P < 0.05]. In this study, pronounced angular instability and marked posterior protrusion of bony fragments in the canal were factors affecting neurological deficits. In addition, marked angular instability was a factor affecting back pain. These findings are useful in determining treatment options for patients with insufficient union following OVF.