【作者】 杨杰；

【导师】 窦强兵；

【作者基本信息】 安徽医科大学 ， 外科学（骨外）， 2023， 硕士

【摘要】 目的:随着人口老龄化的加剧,老年人骨量下降,骨质疏松患者愈发增多,骨质疏松性骨折的发病率也随之增加,骨质疏松性骨折可发生于四肢骨及脊柱,除髋部骨折外,椎体压缩性骨折占其中的绝大部分。此类患者仅因轻微外力作用即可发生,患者腰背部剧烈疼痛,绝对卧床后有所缓解,部分患者远期丧失日常生活能力,严重降低患者生活质量。临床中发现因某些因素的不同,骨折患者预后情况存在差异。本文对影响此类患者获得良好预后的相关代表性因素进行回顾性分析,研究影响胸腰段椎体骨质疏松性骨折预后的相关因素,对明确的危险因素进行积极的干预,可在一定程度上避免或降低不良预后的发生。方法:本研究通过对2020年1月至2021年10月就诊我院骨质疏松性椎体骨折患者进行回顾性分析,通过筛选,共计313例纳入研究。根据住院信息,记录所有患者其年龄、性别、体重指数、骨密度、伤椎MRI类型、是否单椎体骨折、是否行手术治疗、是否累及中后柱、既往是否有糖尿病病史、是否规律抗骨质疏松治疗,以出院12个月后应用Barthel指数评价患者预后。根据Barthel指数将得分在60分以上归为预后良好组,将得分在60分以下归为预后不良组。研究影响胸腰段椎体骨质疏松性椎体压缩性骨折的影响因素,采用SPSS 22.0统计软件进行分析,计量资料以均数±标准差表示,计数资料采用卡方检验,采用非条件Logistic回归模型分析影响骨折预后相关因素。结果:313例中预后良好279例(预后良好组),预后不良34例(预后不良组),两组单因素分析检验结果显示:年龄(?(17)=0.377,P=0.770)、性别(?(17)=0.235,P=0.628)、骨密度(?(17)=1.448,P=0.230)、是否单椎体骨折(?(17)=1.243,P=0.266)、是否行手术治疗(?(17)=0.082,P=0.775)、是否累及中后柱(?(17)=1.412,P=0.236)及是否具有糖尿病病史(?(17)=1.347,P=0.247)差异无统计学意义;而身体质量指数(?(17)=18.611,P=0.000)、伤椎MRI类型(?(17)=96.399,P=0.000)及是否规律抗骨质疏松治疗(?(17)=341.028,P=0.000)差异有统计学意义。多元Logistic回归分析结果提示:高BMI(OR=0.067,P=0.006)、伤椎MRI表现为弥漫型低信号(OR=0.076,P=0.021)及不规律抗骨质疏松治疗(OR=128.262,P=0.000)是影响骨质疏松性椎体压缩性骨折预后不良的独立危险因素。结论:脊柱因其特殊生理骨性结构、受力等问题,是骨质疏松性骨折最常见的部位。骨质疏松性椎体压缩性骨折患者高身体质量指数时其脊柱所受压力更大,影响骨折预后;伤椎MRI表现为弥漫性低信号时,伤椎内水肿严重,伤椎破坏范围大,影响骨折预后;未进行规律抗骨质疏松治疗不利于骨再生,影响骨折预后。更多还原

【Abstract】 Objective With the aging of the population,the bone mass of the elderly is declining,and the number of osteoporosis patients is increasing.The incidence rate of osteoporotic fractures is also increasing.Osteoporotic fractures can occur in the bones of the limbs and spine.In addition to hip fractures,vertebral compression fractures account for the vast majority of them.This kind of patients can only occur due to slight external force.The patients have severe pain in their back and waist,which can be relieved after absolute bed rest.Some patients have lost their ability of daily living in the long term,which seriously reduces their quality of life.It is found that the prognosis of fracture patients is different due to some factors.In this paper,we retrospectively analyzed the relevant representative factors that affect the good prognosis of such patients,studied the relevant factors that affect the prognosis of thoracolumbar vertebral osteoporotic fracture,and actively intervened with clear risk factors,which can avoid or reduce the occurrence of bad prognosis to a certain extent.Method This study retrospectively analyzed the patients with osteoporotic vertebral fracture who visited our hospital from January 2020 to October 2021.Through screening,a total of 313 patients were included in the study.According to the hospitalization information,record the age,sex,body mass index,bone density,MRI type of injured vertebra,whether there is single vertebral fracture,whether there is surgical treatment,whether there is central and posterior column involvement,whether there is a history of diabetes in the past,whether there is regular anti osteoporosis treatment,and evaluate the prognosis of patients with Barthel index 12 months after discharge.According to Barthel index,a score above 60 points is classified as a good prognosis group,and a score below 60 points is classified as a bad prognosis group.To study the influencing factors of thoracolumbar vertebral osteoporotic vertebral compression fracture,SPSS 22.0 statistical software was used for analysis.The measurement data were expressed as mean ± standard deviation,the counting data were used for chi-square test,and the non-conditional logistic regression model was used to analyze the relevant factors affecting fracture prognosis.Results Of the 313 cases,279 had a good prognosis(good prognosis group)and 34 had a bad prognosis(bad prognosis group).The results of univariate analysis of the two groups showed that age(=0.377,P=0.770),sex(=0.235,P=0.628),bone mineral density(=1.448,P=0.230),whether single vertebral fracture(=1.243,P=0.266),whether surgical treatment(=0.082,P=0.775)There was no significant difference in whether the middle and posterior columns were involved(=1.412,P=0.236)and whether there was a history of diabetes(=1.347,P=0.247);There were significant differences in body mass index(=18.611,P=0.000),MRI type of injured vertebra(=96.399,P=0.000)and whether anti-osteoporosis treatment was regular(=341.028,P=0.000).The results of multiple logistic regression analysis showed that high BMI(OR=0.067,P=0.006),diffuse low signal(OR=0.076,P=0.021)and irregular anti-osteoporosis treatment(OR=128.262,P=0.000)were independent risk factors for poor prognosis of osteoporotic vertebral compression fracture.Conclusion Spine is the most common part of osteoporotic fracture due to its special physiological bone structure and stress.The patients with osteoporotic vertebral compression fracture suffered more pressure on their spine when their body mass index was high,which affected the fracture prognosis;When the MRI of the injured vertebra showed diffuse low signal,the edema in the injured vertebra was serious,and the damaged vertebra was extensive,which affected the prognosis of the fracture;Failure to carry out regular anti-osteoporosis treatment is not conducive to bone regeneration and affects fracture prognosis.更多还原