[A clinic analysis of thoracolumbar vertebral fracture cascade]

Zhonghua Yi Xue Za Zhi. 2018 Jun 19;98(23):1844-1848. doi: 10.3760/cma.j.issn.0376-2491.2018.23.008.
[Article in Chinese]

Abstract

Objective: To observe the clinical characteristics of thoracolumbar vertebral fracture cascade, analyze the relationship between the baseline fractures and the subsequent fractures and compare the distribution differences of subsequent fractures following vertebral augmentation or non-operation. Methods: From July 2012 to August 2016, 1 363 patients admitted to the First Affiliated Hospital of Soochow University with vertebral augmentation for the treatment of vertebral fractures were retrospectively analyzed.There were 190 cases of vertebral fracture cascade, 160 females and 30 males, with an average age of (74±9) years.The location and sequence of all vertebral fractures were recorded.The relationships between the baseline and the subsequent fractures were analyzed.According to different treatment on the baseline vertebral fractures, 190 cases were divided into vertebral augmentation group and non-operation group.The distribution differences of the subsequent fractures following vertebral augmentation and non-operation were compared with chi-square test. Results: Vertebral fracture cascade mainly located in the thoracolumbar spine T(11)-L(2) with an incidence of 52.0%.According to the direction of fracture development, the fracture cascade could be divided into up, down, centrifugation and concentration, and the incidence was 39.8%, 39.2%, 8.4% and 12.6%, respectively.The closer the vertebral body to the baseline fractures, the subsequent fractures incidence was higher.For distance with zero, one, two, three and four vertebrae, the incidence of subsequent vertebral fractures was 36.5%, 26.2%, 15.2%, 11.5% and 3.7%, respectively.A linear relationship was found between the subsequent fractures and the baseline fractures with a correlation coefficient of 0.90.The distribution difference of subsequent fractures between vertebral augmentation and non-operation group was not significant (χ(2)=17.16, P>0.05). Conclusions: The main directions of vertebral fracture cascade is up or down spiral development.The closer the vertebral body to the baseline fractures, the subsequent fractures incidence is higher.Vertebral augmentation doesn't affect the distribution of subsequent fractures.

目的: 观察胸腰椎级联骨折的临床特征,分析椎体级联骨折和初始骨折的相关性,比较椎体强化术和未手术治疗对级联骨折分布的影响。 方法: 回顾性分析2012年7月至2016年8月1 363例因椎体骨折在苏州大学附属第一医院骨科行椎体强化治疗患者的临床资料,其中存在椎体级联骨折190例,女160例、男30例,平均年龄(74±9)岁。统计所有初始椎体骨折和级联骨折发生部位和顺序,分析级联骨折与初始骨折的相关性。按初始椎体骨折治疗情况分为椎体强化组和未手术组,应用χ(2)检验比较椎体强化术和未手术治疗对级联骨折的影响。 结果: 椎体级联骨折主要分布于胸腰段(T(11)~L(2))比例占52.0%,按发展趋势分为:向上、向下、两端和中间发生率分别为39.8%、39.2%、8.4%和12.6%。距离初始骨折椎体越近级联骨折发生率越高:相邻椎体骨折发生率为36.5%;间隔1、2、3、4个椎体,级联骨折发生率分别为26.2%、15.2%、11.5%和3.7%。级联骨折与初始骨折的分布存在线性相关,Person相关系数r=0.90。椎体强化和未手术治疗对椎体级联骨折的分布差异无统计学意义(χ(2)=17.16,P>0.05)。 结论: 椎体级联骨折主要以胸腰段为中心向上或向下发展,距离初始骨折椎体越近级联骨折发生率越高,椎体强化术不影响椎体级联骨折发生的分布。.

Keywords: Fracture cascade; Lumber vertebra; Thoracic vertebra; Vertebral body.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Fracture Fixation, Internal
  • Humans
  • Lumbar Vertebrae
  • Male
  • Retrospective Studies
  • Spinal Fractures*
  • Thoracic Vertebrae