Effect of an intensive conservative therapy with daily teriparatide administration and rehabilitation for osteoporotic delayed vertebral collapse and paralysis.
Effect of an intensive conservative therapy with daily teriparatide administration and rehabilitation for osteoporotic delayed vertebral collapse and paralysis.
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DOI：
10.1097/md.0000000000010906
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发表时间：
2018-06
期刊：
影响因子：
1.6
通讯作者：
Deie M
中科院分区：
文献类型：
--
作者：
Wakao N;Takeuchi M;Riew DK;Hirasawa A;Imagama S;Kawanami K;Matsuo T;Murotani K;Deie M
虽然骨化性迟发性椎体塌陷（ODVC）的患者经常接受手术治疗，但保守治疗的疗效和局限性尚未见报道。本研究的目的是探讨ODVC患者进一步强化保守治疗的有效性和局限性。2011年至2014年接受ODVC治疗且随访期超过1年的患者符合条件。基本的治疗策略包括手术治疗，强化的保守治疗，每日特立普和康复治疗3个月。我们对因长期下肢瘫痪或无法忍受的背痛而无法自行保持站立位的患者进行了手术治疗。以手术治疗为客观变量，以性别、年龄、受累椎体水平、瘫痪质量、椎管侵犯变化率（δ）、局部后凸角、塌陷椎体活动度、EuroQol问卷（EQ5D）、数字评定量表（NRS）和Frankel分级等相关因素为解释变量，建立Logistic回归模型。我们还绘制了受试者工作曲线（ROC），以研究基线参数的截止值。入组了30例患者（6例男性和24例女性，平均年龄76.7岁）。最终，30名患者中有12名因症状改善而避免手术治疗。逻辑回归显示，局部后凸角δ（优势比：1.072，P =.01）、塌陷椎骨的活动度（1.063，0.01）、EQ 5D（0.98，0.04）和NRS（1.113，0.01）与手术治疗的需要显着相关。 在基线时的因素中，只有塌陷椎骨的活动度显示出显著的曲线下面积值（AUC = 0.727，P = 0.008）。 40%的ODVC患者经保守治疗后无需进一步手术治疗，具有重要意义。塌陷椎骨活动度较大的患者应尽快手术治疗。
Although patients with osteoporotic delayed vertebral collapse (ODVC) have frequently been treated surgically, the efficacy and limitation of conservative treatment for it have not yet been reported. The purpose of this study was to investigate the effectiveness and limitation of further intensive conservative treatment for patients with ODVC. Patients treated for ODVC from 2011 to 2014 with a follow-up period of more than 1 year were eligible. The fundamental treatment strategy consisted of surgical treatment following intensive conservative treatment with daily teriparatide and rehabilitation for 3 months. We conducted a surgical treatment for patients who could not keep standing position by themselves because of prolonged leg paralysis or intolerable back pain. We performed a logistic regression model in which surgical treatment was set as an objective variable, and other related factors including sex, age, the level of affected vertebrae, the quality of paralysis, changing rate (δ) of spinal canal encroachment, local kyphotic angle, mobility of collapsed vertebrae, EuroQol questionnaires (EQ5D), numerical rating scale (NRS), and Frankel grade as explanatory variables. We also plotted receiver operating curves (ROCs) to investigate the cutoff values of parameters at the baseline. Thirty patients (6 males and 24 females, mean age 76.7 years) were enrolled. Eventually 12 out of 30 patients avoided surgical treatment because their symptoms were improved. Logistic regression showed that δ of local kyphotic angle (odds ratio: 1.072), P = .01), mobility of collapsed vertebrae (1.063, 0.01), EQ5D (0.98, 0.04), and NRS (1.113, 0.01) were significantly correlated with the need for surgical treatments. Among the factors at baseline, only the mobility of collapsed vertebrae showed a significant value of area under a curve (AUC = 0.727, P = .008). The results that 40% of patients with ODVC did not need further surgical treatment after the intensive conservative treatment was of great significance. Patients with greater mobility of collapsed vertebrae might be treated surgically as quickly as possible.