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.	冯飞, 邓介超, 唐海. 多发性骨质疏松性椎体压缩骨折中新鲜与陈旧骨折椎体的诊断与鉴别诊断. 中华骨质疏松和骨矿盐疾病杂志, 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.	唐汉武, 林一峰, 孙丽, 等. 骨质疏松性椎体压缩性骨折的临床特点分析. 广州中医药大学学报, 2014, 31(1): 7-10.
7.	Lirani-Galvão 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.	中华医学会骨科学分会骨质疏松学组. 骨质疏松性骨折诊疗指南. 中华骨科杂志, 2017, 37(1): 1-10.
10.	万丽娟, 李楠, 李春霖, 等. 性激素及性激素结合球蛋白与老年男性骨转换标志物的相关性. 中华骨质疏松和骨矿盐疾病杂志, 2015, 8(2): 112-118.
11.	Grazio S, Korsić M, Jajić 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.	张如云, 张奇, 杨宗酉, 等. 2454例老年骨折患者回顾性分析. 中国临床医生, 2014, 42(5): 40-42.
13.	温勇, 杨立进, 陈博来, 等. 骨质疏松椎体压缩性骨折手术患者1079例临床特征分析. 广东医学, 2019, 40(5): 680-684.
14.	李德勇, 黄海. 胸腰段脊柱骨折的治疗进展. 医学综述, 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.	杨惠林. 科学认识椎体成形术与椎体后凸成形术的临床价值. 中国脊柱脊髓杂志, 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.	张子龙, 井齐明, 乔瑞, 等. 骨质疏松性椎体压缩骨折经皮椎体成形术后邻近椎体新发骨折的危险因素分析. 中国修复重建外科杂志, 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.	马远征, 王以朋, 刘强, 等. 中国老年骨质疏松诊疗指南(2018). 中国老年学杂志, 2019, 39(11): 2561-2579.
22.	杨志宏, 杨桂凤, 郜琳, 等. 老年女性骨密度与体重指数的关系研究. 中国实验诊断学, 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, 谢平金, 万雷, 等. 体重及体质量指数与骨质疏松性骨折发生的关系研究. 中国骨质疏松杂志, 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.	张志伟, 李利, 黄兹谕, 等. 单、双侧椎弓根入路及单侧椎弓根外入路椎体成形治疗胸腰段椎体压缩性骨折: 骨水泥灌注量与渗漏率. 中国组织工程研究, 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.	王开荣. 经皮椎体成形术、经皮椎体后凸成形术治疗老年腰椎压缩性骨折的疗效比较. 中国继续医学教育, 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.	钟远鸣, 程俊, 仇振茂, 等. 单双侧经椎弓根入路PVP治疗骨质疏松性椎体压缩性骨折的Meta分析. 中国矫形外科杂志, 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. 经皮椎体成形术治疗骨质疏松型胸腰椎压缩性骨折的临床评价. 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.	刘进, 唐静, 陈果, 等. 夹心椎与普通邻椎再骨折风险比较及危险因素分析. 中国修复重建外科杂志, 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. 冯飞, 邓介超, 唐海. 多发性骨质疏松性椎体压缩骨折中新鲜与陈旧骨折椎体的诊断与鉴别诊断. 中华骨质疏松和骨矿盐疾病杂志, 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. 唐汉武, 林一峰, 孙丽, 等. 骨质疏松性椎体压缩性骨折的临床特点分析. 广州中医药大学学报, 2014, 31(1): 7-10.
7. Lirani-Galvão 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. 中华医学会骨科学分会骨质疏松学组. 骨质疏松性骨折诊疗指南. 中华骨科杂志, 2017, 37(1): 1-10.
10. 万丽娟, 李楠, 李春霖, 等. 性激素及性激素结合球蛋白与老年男性骨转换标志物的相关性. 中华骨质疏松和骨矿盐疾病杂志, 2015, 8(2): 112-118.
11. Grazio S, Korsić M, Jajić 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. 张如云, 张奇, 杨宗酉, 等. 2454例老年骨折患者回顾性分析. 中国临床医生, 2014, 42(5): 40-42.
13. 温勇, 杨立进, 陈博来, 等. 骨质疏松椎体压缩性骨折手术患者1079例临床特征分析. 广东医学, 2019, 40(5): 680-684.
14. 李德勇, 黄海. 胸腰段脊柱骨折的治疗进展. 医学综述, 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. 杨惠林. 科学认识椎体成形术与椎体后凸成形术的临床价值. 中国脊柱脊髓杂志, 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. 张子龙, 井齐明, 乔瑞, 等. 骨质疏松性椎体压缩骨折经皮椎体成形术后邻近椎体新发骨折的危险因素分析. 中国修复重建外科杂志, 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. 马远征, 王以朋, 刘强, 等. 中国老年骨质疏松诊疗指南(2018). 中国老年学杂志, 2019, 39(11): 2561-2579.
22. 杨志宏, 杨桂凤, 郜琳, 等. 老年女性骨密度与体重指数的关系研究. 中国实验诊断学, 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, 谢平金, 万雷, 等. 体重及体质量指数与骨质疏松性骨折发生的关系研究. 中国骨质疏松杂志, 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. 张志伟, 李利, 黄兹谕, 等. 单、双侧椎弓根入路及单侧椎弓根外入路椎体成形治疗胸腰段椎体压缩性骨折: 骨水泥灌注量与渗漏率. 中国组织工程研究, 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. 王开荣. 经皮椎体成形术、经皮椎体后凸成形术治疗老年腰椎压缩性骨折的疗效比较. 中国继续医学教育, 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. 钟远鸣, 程俊, 仇振茂, 等. 单双侧经椎弓根入路PVP治疗骨质疏松性椎体压缩性骨折的Meta分析. 中国矫形外科杂志, 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. 经皮椎体成形术治疗骨质疏松型胸腰椎压缩性骨折的临床评价. 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. 刘进, 唐静, 陈果, 等. 夹心椎与普通邻椎再骨折风险比较及危险因素分析. 中国修复重建外科杂志, 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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