背景:Domino骨质疏松性椎体骨折(OVFs)涉及多个OVFs同时或依次发生,在最初的OVF愈合之前。然而,多米诺OVFs的危险因素和长期临床结局尚不清楚.
目的:确定与多米诺OVF相关的危险因素,并评估其对患者生活质量(QOL)的影响。
方法:多中心前瞻性观察队列研究。
方法:8家医院保守治疗急性OVF的患者(n=190),随访12个月。
方法:使用视觉模拟量表(VAS)评估临床结果,Oswestry残疾指数(ODI),和日本骨科协会背痛评估问卷(JOABPEQ)。进行多因素分析以确定多米诺OVF的危险因素。
方法:所有患者在3个月时接受磁共振成像(MRI)以检测随后的多米诺OVFs。DominoOVF组包括初始多米诺OVF(基线时多次急性OVF)和随后3个月的多米诺OVF。使用腰椎压痕值和Goutallier分类进行椎旁肌评估。患者特征,骨质量,椎旁肌肉退化,营养状况,射线照相参数,比较非多米诺和多米诺OVF组的QOL评分。
结果:我们评估了50例(26.3%)患有多米诺OVF的患者(34例患有初始多米诺OVF;20例患有随后的多米诺OVF)。多米诺骨牌组的行走能力比非多米诺骨牌OVF组差,从基线到12个月的随访。具有三个或更多相邻多米诺骨牌OVF的组显示较差的VAS和ODI评分。多因素logistic回归分析显示,椎旁肌严重脂肪变性是多米诺OVFs的独立危险因素。
结论:严重的椎旁肌脂肪变性是多米诺型OVFs的独立危险因素。我们的研究表明,质量,而不是数量,椎旁肌肉对多米诺OVF有影响。早期评估椎旁肌肉的脂肪变性对于预测多米诺OVF的发展至关重要。
BACKGROUND: Domino osteoporotic vertebral fractures (OVFs) involve multiple OVFs occurring simultaneously or sequentially, before healing of the initial OVFs. However, the risk factors and long-term clinical outcomes of domino OVFs are unclear.
OBJECTIVE: To identify the risk factors associated with domino OVFs and to assess their impact on patients\' quality of life (QOL).
METHODS: Multicenter prospective observational cohort study.
METHODS: Patients (n = 190) treated conservatively for acute OVFs in 8 hospitals with 12-month follow-up.
METHODS: Clinical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Multivariate analyses were performed to identify risk factors for domino OVFs.
METHODS: All patients underwent magnetic resonance imaging (MRI) at 3 months to detect subsequent domino OVFs. Domino OVF group included initial domino OVFs (multiple acute OVFs at baseline) and subsequent domino OVFs at 3 months. Paraspinal muscle assessment was performed using the lumbar indentation value and Goutallier classification. Patient characteristics, bone quality, paravertebral muscle degeneration, nutritional status, radiographic parameters, and QOL scores were compared between the nondomino and domino OVF groups.
RESULTS: We evaluated 50 (26.3%) patients with domino OVFs (34 with initial domino OVFs; 20 with subsequent domino OVFs). Walking ability was poorer in the domino than in the nondomino OVF group, from baseline to the 12 months follow-up. Groups with 3 or more adjacent domino OVFs showed worse VAS and ODI scores. Multivariate logistic regression analysis revealed that severe fatty degeneration of the paraspinal muscle was an independent risk factor for domino OVFs.
CONCLUSIONS: Severe paraspinal muscle fatty degeneration is an independent risk factor for domino OVFs. Our study showed that the quality, rather than the quantity, of paraspinal muscles had an impact on domino OVFs. Early assessment of fatty degeneration in the paraspinal muscles is essential for predicting the development of domino OVFs.