背景:矫正治疗是保守治疗骨质疏松性椎体骨折(OVF)的常用选择。然而,其临床获益证据不足.
目的:探讨矫形治疗OVF的疗效。
方法:回顾性队列研究,数据来自两项前瞻性研究。
方法:本研究纳入了2012年和2020年前瞻性队列研究的160例新鲜OVF患者。
方法:下腰痛的视觉模拟量表(VAS)评分用于临床结局,影像学参数包括椎骨的高度百分比和椎体的角度变化。此外,随着时间的推移,对继发性椎体骨折的发生进行了随访.
方法:将患者分为支具组和无支具组,并根据年龄倾向评分进行匹配,性别,最初检查时的前身高百分比,以及旧OVF的存在。使用广义Wilcoxon检验计算和分析了有和没有支撑的继发性椎体骨折累积发生率的危险比。此外,将支架组分为软支架组和刚性支架组,并与无支架组进行比较。
结果:倾向评分匹配后每组61例。从初次检查到受伤后6个月,下腰痛的VAS改善以及前壁和后壁高度百分比的变化均无显着差异(分别为p=0.87,p=0.39和p=0.14,混合效应模型)。同时,椎骨骨折的平均角度变化最初为4.3°/3.2°,6个月时为1.2°/2.5°(支撑组/无支撑组,分别为;p=0.007,混合效应模型)。在刚性支撑组和无支撑组之间也观察到显着差异(p=0.008,混合效应模型)。术后1个月继发性椎体骨折发生率为1.6%/11.4%,表明有显著差异(支撑组/无支撑组,分别为;p=0.028)。由于矫正治疗导致的继发性骨折的累积发生率的风险比为0.47(95%置信区间0.20-1.09,p=0.054)。
结论:尽管新鲜OVF的矫形治疗不能缓解疼痛,它可能有助于骨折椎骨的稳定,尤其是使用刚性支架。此外,它可能会影响OVF发作后立即减少即将发生的椎骨骨折风险。
方法:临床研究。
BACKGROUND: Orthotic treatment is a common option for the conservative treatment of osteoporotic vertebral fractures (OVF). However, there is insufficient evidence of its clinical benefit.
OBJECTIVE: To investigate the effectiveness of orthotic treatment for OVF.
METHODS: Retrospective cohort study with data from two prospective studies.
METHODS: This study included 160 patients with fresh OVF enrolled in 2012 and 2020 prospective cohort studies.
METHODS: The visual analog scale (VAS) score for low back pain was used for clinical outcomes, and radiographic parameters included the percent height of the vertebra and angular change of the vertebral body. Moreover, the occurrence of secondary vertebral fractures was followed-up over time.
METHODS: The patients were divided into brace and no-brace groups and were matched according to propensity score for age, sex, anterior percent height at the initial examination, and presence of old OVFs. Hazard ratio for the cumulative incidence of secondary vertebral fractures with and without bracing were calculated and analyzed using the generalized Wilcoxon test. In addition, the brace group was divided into soft and rigid brace groups and compared with the no-brace group.
RESULTS: Each group had 61 cases after propensity score matching. There were no significant differences in the VAS improvement for low back pain and the change in percent height of the anterior and posterior walls from initial examination to 6 months after injury (p=.87, p=.39 and p=.14, respectively, mixed-effect models). Meanwhile, the mean angular change of fractured vertebrae was 4.3° / 3.2° initially and 1.2° / 2.5° at 6 months (the brace group / no-brace group, respectively; p=.007, mixed-effect models). A significant difference was also observed between the rigid brace group and the no-brace group (p=.008, mixed effect models). The incidence of secondary vertebral fractures was 1.6% / 11.4% at 1 month, indicating a significant difference (the brace group / no-brace group, respectively; p = .028). The hazard ratio for the cumulative incidence of secondary fractures due to orthotic treatment was 0.47 (95% confidence interval 0.20-1.09, p=.054).
CONCLUSIONS: Although orthotic treatment for fresh OVF did not relieve pain, it might contribute to the stabilization of the fractured vertebra, especially using a rigid brace. Moreover, it might influence a reduction of the imminent vertebral fracture risk immediately after the onset of OVF.
METHODS: Clinical study.