Epidemiological Characteristics of Patients with Thoracolumbar Osteoporotic Fracture

doi:10.12114/j.issn.1007-9572.2018.00.303

Abstract

Abstract: Background　 At present，the epidemiological data on osteoporotic fractures of thoracolumbar spine is insufficient. Therefore，the statistical analysis of big data is urgently needed to provide reference for prevention，clinical diagnosis and treatment of thoracolumbar osteoporotic fracture. Objective　To analyze the epidemiological characteristics of inpatients with thoracolumbar osteoporotic fracture in Honghui Hospital，Xi'an Jiaotong University.Methods　 A total of 4 083 patients with thoracolumbar osteoporotic fracture hospitalized in Honghui Hospital，Xi'an Jiaotong University were included in this study from January 1st 2014 to December 31st 2016.According to age，they were divided into below 60 group（339 cases），60-69 group（1 850 cases），70-79 group（1 421 cases），80-89 group（441 cases），and over 90 group（32 cases）.According to treatment method，patients were divided into minimally invasive surgery group（3 911 cases） and conventional treatment group（172 cases）.Patients' general condition，fracture status and treatment were collected，and T value of bone density and Visual Analogue Scale（VAS） and Oswestry Dysfunction Index（ODI） were evaluated.Results　Male patients with the highest incidence of osteoporotic fracture were in the 70-79 group，and females in the 60-69 group.The incidence among female patients in each group was higher than that in male patients.The greatest incidence difference of osteoporosis fracture between males and females was in below 60 group.The average bone mineral density（T value） of all patients was（-3.2±1.2） SD，including 945 patients（23.14%） with bone density less than -3.5 SD.3 751 patients had at least 1 complication，the most common is cardiovascular diseases（3 278 cases，80.28%），diabetes（645 cases，15.80%），stroke sequelae（529 cases，12.96%）.A total of 245 subjects（6.00%） had high-energy injuries and 3 838 subjects（94.00%） had low-energy injuries.The main cause of fracture is low energy injury.Fractures occurred in 4 953 vertebral bodies.Thoracolumbar fracture segment were unimodal，with the highest proportion at L1（29.09%）；the highest incidence of fracture occurred in thoracolumbar segment（T11~L2），accounting for 77.06%（3 817/4 953） of all vertebrae fracture.Lumbar fracture accounted for 53.46%（2 648/4 953），which was higher than thoracic fracture of 46.54%（2 305/4 953）.There were no spinal cord，nerve and vascular injuries in patients undergone surgeries.Seventy-nine patients had cement leakage but no clinical symptoms.After 3 months of treatment，the T value in the minimally invasive surgery group was higher than that of conventional treatment group；VAS and ODI were lower than those of conventional treatment group；the incidence of deep vein thrombosis and lung infection was lower than that of conventional treatment group and bed time was shorter than that of conventional group（P<0.05）.Conclusion　The incidence of osteoporotic fracture in thoracolumbar spine is higher in female patients than that in males.The main cause of fracture is low energy injury，and mostly occurs in thoracolumbar region.Lumbar vertebrae fracture is more common than thoracic vertebrae fracture.Vertebroplasty or kyphoplasty is the main treatment.

Key words: Osteoporotic fractures, Thoracic vertebrae, Lumbar vertebrae, Epidemiology

摘要： 背景　目前，关于胸腰椎骨质疏松性骨折的相关流行病学调查较少，且现有的调查存在数据较少、资料欠完善等不足。因此急需大数据的病例资料统计分析，为胸腰椎骨质疏松性骨折的预防、临床诊断和治疗提供参考依据。目的　调查西安交通大学附属红会医院胸腰椎骨质疏松性骨折住院患者的流行病学特点。方法　选取2014-01-01至2016-12-31在西安交通大学附属红会医院住院的胸腰椎骨质疏松性骨折患者4 083例，按照年龄分为<60岁组（339例）、60~69岁组（1 850例）、70~79岁组（1 421例）、80~89岁组（441例）、≥90岁组（32例），依据治疗方式分为微创手术治疗组（3 911例）和保守治疗组（172例）。收集患者的一般情况、骨折情况、治疗情况等资料，测定骨密度T值，采用疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）进行评价。结果　男性以70~79岁高发，女性以60~69岁高发，各组女性均多于男性，<60岁组男女比例最大；平均骨密度T值为（-3.2±1.2）SD，骨密度<-3.5 SD者945例（23.14%）。3 751例患者伴至少1种合并症，最常见的合并症为心血管疾病3 278例（80.28%）、糖尿病645例（15.80%）、脑卒中后遗症529例（12.96%）。高能量损伤245例（6.00%），低能量损伤3 838例（94.00%），低能量损伤是主要致伤因素。共4 953个椎体发生骨折，胸腰椎骨折节段大致呈单峰分布，L1所占比例最高为29.09%（1 441/4 953）；胸腰段（T11~L2）为多发节段，占77.06%（3 817/4 953）；腰椎骨折所占比例为53.46%（2 648/4 953），高于胸椎骨折的46.54%（2 305/4 953）。手术患者无脊髓、神经和血管损伤，共79个椎体发生骨水泥渗漏，均无临床症状。微创手术治疗组治疗3个月后骨密度T值大于保守治疗组，VAS、ODI均低于保守治疗组，下肢深静脉血栓、肺部感染发生率均低于保守治疗组，卧床时间短于保守治疗组（P<0.05）。结论　胸腰椎骨质疏松性骨折女性多于男性，骨折原因主要为低能量损伤，骨折部位以胸腰段最为多见，且腰椎多于胸椎，椎体成形术或椎体后凸成形术是主要的治疗手段。

关键词: 骨质疏松性骨折, 胸椎, 腰椎, 流行病学

ZHANG Xuefang,YANG Xiaobin,HAO Dingjun, et al. Epidemiological Characteristics of Patients with Thoracolumbar Osteoporotic Fracture　[J]. Chinese General Practice, 2019, 22(11): 1288-1292. DOI: 10.12114/j.issn.1007-9572.2018.00.303.
章雪芳,杨小彬,郝定均等. 胸腰椎骨质疏松性骨折患者流行病学特点研究[J]. 中国全科医学, 2019, 22(11): 1288-1292. DOI: 10.12114/j.issn.1007-9572.2018.00.303.

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