Epidemiological and clinical characteristics analysis of 681 cases of thoracolumbar osteoporotic vertebral compression fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Hao , PAN Wenqi , ZHANG Youlei ,  XING Chaohui , ZHANG Baiqing , SUN Baoting , ZHEN Zhilei , GONG Liangwei , XU Han

The Second Department of Orthopedics, Beijing DCN Orthopedic Hospital, Beijing, 100143, P. R. China;

Corresponding?author：

XING Chaohui, Email: A001239@naton.cn

Keywords：

Osteoporotic vertebral compression fracture; percutaneous vertebroplasty; epidemiology; clinical characteristics

DOI：

10.7507/1002-1892.202204026

Video：

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Objective To investigate the epidemiological and clinical characteristics of patients with thoracolumbar osteoporotic vertebral compression fracture (OVCF) treated by percutaneous vertebroplasty (PVP). Methods The clinical and imaging data of 681 patients with thoracolumbar OVCF treated with PVP between January 2017 and December 2021 were collected. The epidemiological and clinical characteristics of the patients with thoracolumbar OVCF in single center were summarized from the aspects of demographic distribution (mainly including gender, age), fracture characteristic analysis [including pathological segments, bone mineral density, and body mass index (BMI)], and operation related results (including the distribution of unilateral and bilateral puncture and bone cement injection, postoperative effectiveness analysis and refracture). Results Of the 681 patients, 134 (19.68%) were male and 547 (80.32%) were female, with a male-to-female ratio of 1∶4.08. The age ranged from 53 to 105 years, with an average of 75.3 years. The age group of 60-90 years old had the largest number of patients (91.04%); the high incidence age group of men was 70-90 years old (13.95%), and that of women was 60-80 years old (72.98%). A total of 836 vertebrae were involved, and the morbidity of thoracolumbar vertebrae (T₁₁-L₁) was the highest (56.34%, 471/836). The main type of fracture was compression fracture (92.58%, 774/836) and Kümmell disease (7.42%, 62/836). There were 489 cases (71.81%) of osteoporosis, including 66 males and 423 females, with a male-to-female ratio of 1∶6.42. There was significant difference in distribution of bone mineral density between male and female groups (Z=–5.810, P<0.001). BMI showed 206 cases (30.25%) of underweight, 347 (50.95%) cases of normal, 58 cases (8.52%) of overweight, 42 cases (6.17%) of obese, and 28 cases (4.11%) of extremely obese. The difference in BMI distribution between male and female groups was significant (Z=–2.220, P=0.026). Of 836 vertebral bodies, 472 (56.46%) were punctured unilaterally and 364 (43.54%) bilaterally. Most of the vertebral bodies (49.88%, 417/836) were injected with 5.0-6.9 mL bone cement, and most of them were distributed in thoracolumbar and lumbar vertebral bodies (T₁₁-L₃). The visual analogue scale (VAS) score and Oswestry disability index (ODI) of patients with unilateral puncture and bilateral puncture significantly improved at 6 months after operation (P<0.001), and also the difference was significant between the two groups in the difference of pre- and post-operation (P<0.001). There were 628 cases (92.22%) with the first occurrence of OVCF, and 53 cases (7.78%) with two or more times of OVCF, all of which were female patients, and 26 cases (49.06%) occurred in the adjacent segment of the previous PVP operation. Conclusion Female were more than male in OVCF patients. Thoracolumbar vertebral body has the highest morbidity. Patients with low BMI are more likely to have osteoporosis, and patients with high BMI have a higher risk of compression fracture. The amount of bone cement injected through bilateral puncture was greater than that through unilateral puncture.

Citation： CHEN Hao, PAN Wenqi, ZHANG Youlei, XING Chaohui, ZHANG Baiqing, SUN Baoting, ZHEN Zhilei, GONG Liangwei, XU Han. Epidemiological and clinical characteristics analysis of 681 cases of thoracolumbar osteoporotic vertebral compression fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(7): 873-880. doi: 10.7507/1002-1892.202204026 Copy

1.	Bijlsma AY, Meskers CG, Westendorp RG, et al. Chronology of age-related disease definitions: osteoporosis and sarcopenia. Ageing Res Rev, 2012, 11(2): 320-324.
2.	Wang O, Hu Y, Gong S, et al. A survey of outcomes and management of patients post fragility fractures in China. Osteoporos Int, 2015, 26(11): 2631-2640.
3.	馮飛, 鄧介超, 唐海. 多發性骨質疏松性椎體壓縮骨折中新鮮與陳舊骨折椎體的診斷與鑒別診斷. 中華骨質疏松和骨礦鹽疾病雜志, 2013, 6(2): 132-136.
4.	Papaioannou A, Morin S, Cheung AM, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ, 2010, 182(17): 1864-1873.
5.	Abtahi S, Driessen JHM, Vestergaard P, et al. Secular trends in major osteoporotic fractures among 50+ adults in Denmark between 1995 and 2010. Osteoporos Int, 2019, 30(11): 2217-2223.
6.	唐漢武, 林一峰, 孫麗, 等. 骨質疏松性椎體壓縮性骨折的臨床特點分析. 廣州中醫藥大學學報, 2014, 31(1): 7-10.
7.	Lirani-Galv?o AP, Lazaretti-Castro M. Physical approach for prevention and treatment of osteoporosis. Arq Bras Endocrinol Metabol, 2010, 54(2): 171-178.
8.	Siggeirsdottir K, Aspelund T, Jonsson BY, et al. Epidemiology of fractures in Iceland and secular trends in major osteoporotic fractures 1989-2008. Osteoporos Int, 2014, 25(1): 211-219.
9.	中華醫學會骨科學分會骨質疏松學組. 骨質疏松性骨折診療指南. 中華骨科雜志, 2017, 37(1): 1-10.
10.	萬麗娟, 李楠, 李春霖, 等. 性激素及性激素結合球蛋白與老年男性骨轉換標志物的相關性. 中華骨質疏松和骨礦鹽疾病雜志, 2015, 8(2): 112-118.
11.	Grazio S, Korsi? M, Jaji? I. Prevalence of vertebral fractures in an urban population in Croatia aged fifty and older. Wien Klin Wochenschr, 2005, 117(1-2): 42-47.
12.	張如云, 張奇, 楊宗酉, 等. 2454例老年骨折患者回顧性分析. 中國臨床醫生, 2014, 42(5): 40-42.
13.	溫勇, 楊立進, 陳博來, 等. 骨質疏松椎體壓縮性骨折手術患者1079例臨床特征分析. 廣東醫學, 2019, 40(5): 680-684.
14.	李德勇, 黃海. 胸腰段脊柱骨折的治療進展. 醫學綜述, 2019, 25(1): 124-128.
15.	Lane NE. Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol, 2006, 194(2 Suppl): S3-S11.
16.	Osterhouse MD, Kettner NW. Delayed posttraumatic vertebral collapse with intravertebral vacuum cleft. J Manipulative Physiol Ther, 2002, 25(4): 270-275.
17.	楊惠林. 科學認識椎體成形術與椎體后凸成形術的臨床價值. 中國脊柱脊髓雜志, 2010, 20(6): 441-443.
18.	Heini PF. The current treatment—a survey of osteoporotic fracture treatment. Osteoporotic spine fractures: the spine surgeon’s perspective. Osteoporos Int, 2005, 16 Suppl 2: S85-S92.
19.	張子龍, 井齊明, 喬瑞, 等. 骨質疏松性椎體壓縮骨折經皮椎體成形術后鄰近椎體新發骨折的危險因素分析. 中國修復重建外科雜志, 2021, 35(1): 20-25.
20.	Piao M, Darwono AB, Zhu K, et al. Extrapendicular approach of unilateral percutaneous vesselplasty for the treatment of kummell disease. Int J Spine Surg, 2019, 13(2): 199-204.
21.	馬遠征, 王以朋, 劉強, 等. 中國老年骨質疏松診療指南(2018). 中國老年學雜志, 2019, 39(11): 2561-2579.
22.	楊志宏, 楊桂鳳, 郜琳, 等. 老年女性骨密度與體重指數的關系研究. 中國實驗診斷學, 2014, (11): 1846-1848.
23.	Reinehr T, Roth CL. A new link between skeleton, obesity and insulin resistance: relationships between osteocalcin, leptin and insulin resistance in obese children before and after weight loss. Int J Obes (Lond), 2010, 34(5): 852-858.
24.	Cadenas C, Bolt HM. Estrogen receptors in human disease. Arch Toxicol, 2012, 86(10): 1489-1490.
25.	柴生颋, 謝平金, 萬雷, 等. 體重及體質量指數與骨質疏松性骨折發生的關系研究. 中國骨質疏松雜志, 2018, 24(2): 156-160.
26.	Tanaka S, Kuroda T, Saito M, et al. Overweight/obesity and underweight are both risk factors for osteoporotic fractures at different sites in Japanese postmenopausal women. Osteoporos Int, 2013, 24(1): 69-76.
27.	Li LH, Sun TS, Liu Z, et al. Comparison of unipedicular and bipedicular percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures: a meta-analysis. Chin Med J (Engl), 2013, 126(20): 3956-3961.
28.	張志偉, 李利, 黃茲諭, 等. 單、雙側椎弓根入路及單側椎弓根外入路椎體成形治療胸腰段椎體壓縮性骨折: 骨水泥灌注量與滲漏率. 中國組織工程研究, 2020, 24(9): 1353-1358.
29.	Liang L, Chen X, Jiang W, et al. Balloon kyphoplasty or percutaneous vertebroplasty for osteoporotic vertebral compression fracture? An updated systematic review and meta-analysis Ann Saudi Med, 2016, 36(3): 165-174.
30.	王開榮. 經皮椎體成形術、經皮椎體后凸成形術治療老年腰椎壓縮性骨折的療效比較. 中國繼續醫學教育, 2016, 8(23): 110-111.
31.	Kolb JP, Kueny RA, Püschel K, et al. Does the cement stiffness affect fatigue fracture strength of vertebrae after cement augmentation in osteoporotic patients? Eur Spine J, 2013, 22(7): 1650-1656.
32.	鐘遠鳴, 程俊, 仇振茂, 等. 單雙側經椎弓根入路PVP治療骨質疏松性椎體壓縮性骨折的Meta分析. 中國矯形外科雜志, 2014, 22(10): 892-897.
33.	Pang J, Liu B, Chen H, et al. Precise puncture combined with simplified percutaneous vertebroplasty to treat osteoporotic vertebral compression fractures: a comparative analysis with conventional percutaneous vertebroplasty. Am J Transl Res, 2021, 13(12): 14195-14202.
34.	Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine (Phila Pa 1976), 2001, 26(14): 1547-1554.
35.	遇呈祥, 王忠平, 邱渝江, 等. 經皮椎體成形術治療骨質疏松型胸腰椎壓縮性骨折的臨床評價. 骨科, 2015, 6(4): 196-200.
36.	Zhuo Y, Liu L, Wang H, et al. A modified transverse process-pedicle approach applied to unilateral extrapedicular percutaneous vertebroplasty. Pain Res Manag, 2021, 2021: 6493712. doi: 10.1155/2021/6493712.
37.	劉進, 唐靜, 陳果, 等. 夾心椎與普通鄰椎再骨折風險比較及危險因素分析. 中國修復重建外科雜志, 2021, 35(9): 1161-1166.

1. Bijlsma AY, Meskers CG, Westendorp RG, et al. Chronology of age-related disease definitions: osteoporosis and sarcopenia. Ageing Res Rev, 2012, 11(2): 320-324.
2. Wang O, Hu Y, Gong S, et al. A survey of outcomes and management of patients post fragility fractures in China. Osteoporos Int, 2015, 26(11): 2631-2640.
3. 馮飛, 鄧介超, 唐海. 多發性骨質疏松性椎體壓縮骨折中新鮮與陳舊骨折椎體的診斷與鑒別診斷. 中華骨質疏松和骨礦鹽疾病雜志, 2013, 6(2): 132-136.
4. Papaioannou A, Morin S, Cheung AM, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ, 2010, 182(17): 1864-1873.
5. Abtahi S, Driessen JHM, Vestergaard P, et al. Secular trends in major osteoporotic fractures among 50+ adults in Denmark between 1995 and 2010. Osteoporos Int, 2019, 30(11): 2217-2223.
6. 唐漢武, 林一峰, 孫麗, 等. 骨質疏松性椎體壓縮性骨折的臨床特點分析. 廣州中醫藥大學學報, 2014, 31(1): 7-10.
7. Lirani-Galv?o AP, Lazaretti-Castro M. Physical approach for prevention and treatment of osteoporosis. Arq Bras Endocrinol Metabol, 2010, 54(2): 171-178.
8. Siggeirsdottir K, Aspelund T, Jonsson BY, et al. Epidemiology of fractures in Iceland and secular trends in major osteoporotic fractures 1989-2008. Osteoporos Int, 2014, 25(1): 211-219.
9. 中華醫學會骨科學分會骨質疏松學組. 骨質疏松性骨折診療指南. 中華骨科雜志, 2017, 37(1): 1-10.
10. 萬麗娟, 李楠, 李春霖, 等. 性激素及性激素結合球蛋白與老年男性骨轉換標志物的相關性. 中華骨質疏松和骨礦鹽疾病雜志, 2015, 8(2): 112-118.
11. Grazio S, Korsi? M, Jaji? I. Prevalence of vertebral fractures in an urban population in Croatia aged fifty and older. Wien Klin Wochenschr, 2005, 117(1-2): 42-47.
12. 張如云, 張奇, 楊宗酉, 等. 2454例老年骨折患者回顧性分析. 中國臨床醫生, 2014, 42(5): 40-42.
13. 溫勇, 楊立進, 陳博來, 等. 骨質疏松椎體壓縮性骨折手術患者1079例臨床特征分析. 廣東醫學, 2019, 40(5): 680-684.
14. 李德勇, 黃海. 胸腰段脊柱骨折的治療進展. 醫學綜述, 2019, 25(1): 124-128.
15. Lane NE. Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol, 2006, 194(2 Suppl): S3-S11.
16. Osterhouse MD, Kettner NW. Delayed posttraumatic vertebral collapse with intravertebral vacuum cleft. J Manipulative Physiol Ther, 2002, 25(4): 270-275.
17. 楊惠林. 科學認識椎體成形術與椎體后凸成形術的臨床價值. 中國脊柱脊髓雜志, 2010, 20(6): 441-443.
18. Heini PF. The current treatment—a survey of osteoporotic fracture treatment. Osteoporotic spine fractures: the spine surgeon’s perspective. Osteoporos Int, 2005, 16 Suppl 2: S85-S92.
19. 張子龍, 井齊明, 喬瑞, 等. 骨質疏松性椎體壓縮骨折經皮椎體成形術后鄰近椎體新發骨折的危險因素分析. 中國修復重建外科雜志, 2021, 35(1): 20-25.
20. Piao M, Darwono AB, Zhu K, et al. Extrapendicular approach of unilateral percutaneous vesselplasty for the treatment of kummell disease. Int J Spine Surg, 2019, 13(2): 199-204.
21. 馬遠征, 王以朋, 劉強, 等. 中國老年骨質疏松診療指南(2018). 中國老年學雜志, 2019, 39(11): 2561-2579.
22. 楊志宏, 楊桂鳳, 郜琳, 等. 老年女性骨密度與體重指數的關系研究. 中國實驗診斷學, 2014, (11): 1846-1848.
23. Reinehr T, Roth CL. A new link between skeleton, obesity and insulin resistance: relationships between osteocalcin, leptin and insulin resistance in obese children before and after weight loss. Int J Obes (Lond), 2010, 34(5): 852-858.
24. Cadenas C, Bolt HM. Estrogen receptors in human disease. Arch Toxicol, 2012, 86(10): 1489-1490.
25. 柴生颋, 謝平金, 萬雷, 等. 體重及體質量指數與骨質疏松性骨折發生的關系研究. 中國骨質疏松雜志, 2018, 24(2): 156-160.
26. Tanaka S, Kuroda T, Saito M, et al. Overweight/obesity and underweight are both risk factors for osteoporotic fractures at different sites in Japanese postmenopausal women. Osteoporos Int, 2013, 24(1): 69-76.
27. Li LH, Sun TS, Liu Z, et al. Comparison of unipedicular and bipedicular percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures: a meta-analysis. Chin Med J (Engl), 2013, 126(20): 3956-3961.
28. 張志偉, 李利, 黃茲諭, 等. 單、雙側椎弓根入路及單側椎弓根外入路椎體成形治療胸腰段椎體壓縮性骨折: 骨水泥灌注量與滲漏率. 中國組織工程研究, 2020, 24(9): 1353-1358.
29. Liang L, Chen X, Jiang W, et al. Balloon kyphoplasty or percutaneous vertebroplasty for osteoporotic vertebral compression fracture? An updated systematic review and meta-analysis Ann Saudi Med, 2016, 36(3): 165-174.
30. 王開榮. 經皮椎體成形術、經皮椎體后凸成形術治療老年腰椎壓縮性骨折的療效比較. 中國繼續醫學教育, 2016, 8(23): 110-111.
31. Kolb JP, Kueny RA, Püschel K, et al. Does the cement stiffness affect fatigue fracture strength of vertebrae after cement augmentation in osteoporotic patients? Eur Spine J, 2013, 22(7): 1650-1656.
32. 鐘遠鳴, 程俊, 仇振茂, 等. 單雙側經椎弓根入路PVP治療骨質疏松性椎體壓縮性骨折的Meta分析. 中國矯形外科雜志, 2014, 22(10): 892-897.
33. Pang J, Liu B, Chen H, et al. Precise puncture combined with simplified percutaneous vertebroplasty to treat osteoporotic vertebral compression fractures: a comparative analysis with conventional percutaneous vertebroplasty. Am J Transl Res, 2021, 13(12): 14195-14202.
34. Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine (Phila Pa 1976), 2001, 26(14): 1547-1554.
35. 遇呈祥, 王忠平, 邱渝江, 等. 經皮椎體成形術治療骨質疏松型胸腰椎壓縮性骨折的臨床評價. 骨科, 2015, 6(4): 196-200.
36. Zhuo Y, Liu L, Wang H, et al. A modified transverse process-pedicle approach applied to unilateral extrapedicular percutaneous vertebroplasty. Pain Res Manag, 2021, 2021: 6493712. doi: 10.1155/2021/6493712.
37. 劉進, 唐靜, 陳果, 等. 夾心椎與普通鄰椎再骨折風險比較及危險因素分析. 中國修復重建外科雜志, 2021, 35(9): 1161-1166.

Chinese Journal of Reparative and Reconstructive Surgery

Epidemiological and clinical characteristics analysis of 681 cases of thoracolumbar osteoporotic vertebral compression fractures

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