골다공증성 척추 골절의 보존적 치료에 대한 생존 분석 = Survival Analysis of Conservative Treatement in Osteoporotic Vertebral Fracture

국문 초록 (Abstract)

연구 계획: 전향적 연구목적: 골다공증성 척추 골절에서 보존적 치료에 대한 생존율을 분석하여 그에 영향을 미치는 예후 인자를 알아보고자 하였다.
선행문헌의 요약: 최근 고령인구의 증가와 그에 따른 골다공증에 대한 많은 연구가 이루어져 골다공증성 척추 골절은 중대한 합병증을 낳는다고 보고되고 있다. 그러나 아직 그 치료 및 예후에 대하여 명확히 알려진 바는 없다.
대상 및 방법: 한 추체의 골다공증성 척추 골절로 보존적 치료를 받았던 130명의 환자를 대상으로 보존적 치료에 대한 생존분석을 시행하였다. 또한 수상 당시의 나이, 성별, 체질량 지수(BMI), 골밀도 검사, 흡연의 여부, 당뇨의 유병 여부, 골절 부위, 골절 형태, 추체 압박률, 국소 분절 후만각을 측정하여,생존에 대한 단 인자 및 다중 인자 분석을 시행하였다.
결과: 보존적 치료에 대한 생존율은 70.7% 였다. 단 인자 분석상 수상 당시의 나이가 78세 이상(p=0.008), 골밀도 검사상 T 점수 -3.5이하(p=0.047), 골절형태가 설상형 보다 양오목형 또는 압착형에서(p=0.021) 생존율이 유의하게 낮은 것으로 분석되었다. 다중 인자 분석에서는 나이에 따른 요인만이유의한 의미를 보였다(p=0.025, Hazard ratio=2.08).
결론: 한 추체의 골다공증성 척추 골절에서 보존적 치료는 70.7%의 생존율을 보였으며, 나이가 보존적 치료의 가장 중요한 인자로 분석 되었다. 나이가78세 이상의 고령인 경우 보존적 치료의 고 위험임을 미리 인지할 필요가 있을 것으로 사료된다.

다국어 초록 (Multilingual Abstract)

Study Design: Prospective study.
Objectives: To define the prognostic factors by analyzing the survival rates of osteoporotic vertebral fracture treated by conservative management.
Summary of Literature Review: Due to an increasing elder population, many recent studies of osteoporosis have been done; pointing out that osteoporotic vertebral fracture may produce serious complications. However, there is nothing obviously demonstrated in both the management and prognosis of the osteoporotic vertebral fracture.
Materials and Methods: Survival analysis was done for 130 patients who had undergone conservative management for a single level vertebral fracture. Univariant and multivariant survival analysis was done for age at trauma, sex, body mass index (BMI), bone mineral density (BMD), smoking, diabetic history, fracture level, fracture type, vertebral compression ratio and regional Cobb’s angle.
Results: Survival rate for conservative management was 70.7%. Univariant analysis for survival rate revealed significantly inferior results for age over 78 (p=0.008), T score< -3.5 (p=0.047), and crush or biconcave type than wedge type (p=0.021). Only the age factor showed significance in multivariant analysis (p=0.025, Hazard ratio=2.08).
Conclusion: Conservative management in a single level osteoporotic vertebral fracture, showed a survival rate of 70.7% and age was the most important factor in conservative management. We should notice that age of more than 78 years is at high risk for failure in conservative management of vertebral fracture.

참고문헌 (Reference)

1 정호원, "흉요추 이행부 단순 압박 및 안정 방출성 골절의 보존적 치료 : 조기 보행군과 지연 보행군의 비교" 대한정형외과학회 37 (37): 14-488, 2002

2 손종민, "진행성 골다공증성 척추골절의 위험인자" 대한척추외과학회 16 (16): 153-159, 2009

3 박희곤, "골다공증에 의한 압박 골절의 경피적 척추 성형술의 부작용" 대한골절학회 16 (16): 14-540, 2003

4 Kado DM, "Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group" 159 : 1215-1220, 1999

5 Suk SI, "Vertebral fracture in Osteoporosis" 28 : 980-987, 1993

6 Weinstein JN, "Thoracolumbar“burst” fractures treated conservatively : a long-term follow-up" 13 : 33-38, 1988

7 Riggs BL, "The worldwide problem of osteoporosis: insights afforded by epidemiology" 17 : 505-511, 1995

8 Reid DC, "The nonoperative treatment of burst fractures of the thoracolumbar junction" 28 : 1188-1194, 1988

9 Lyritis GP, "The natural history of the osteoporotic vertebral fracture" 8 : 66-69, 1989

10 Ahn DK, "The efficacy of kyphoplasty on osteoporotic vertebral compression fracture: a 1-year follow-up study. J Korean Soc Spine Surg. 2009;16:79-882. Roukis TS, Hurless JS. The hallucal interphalangeal sesamoid" 35 : 303-308, 1996

11 Leech JA, "Relationship of lung function to severity of osteoporosis in women" 141 : 68-71, 1990

12 Schlaich C, "Reduced pulmonary function in patients with spinal osteoporotic fractures" 8 : 261-267, 1998

13 Wenger M, "Re: Percutaneous vertebroplasty for pain relief and spinal stabilization" 25 : 2968-2969, 2000

14 Truumees E, "Osteoporosis" 26 : 930-932, 2001

15 Lindsay R, "One year outcomes and costs following a vertebral fracture" 16 : 78-85, 2005

16 Ismail AA, "Number and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. European Vertebral Osteoporosis Study Group" 9 : 206-213, 1999

17 Garfin SR, "New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures" 26 : 1511-1515, 2001

18 Westernborn A, "Mechanics, treatment and prognosis of fractures of the dorso-lumbar spine" 102 : 59-83, 1951

19 Diamond TH, "Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy" 114 : 257-265, 2003

20 Kanchiku T, "Magnetic resonance imaging diagnosis and new classification of the osteoporotic vertebral fracture" 8 : 463-466, 2003

21 Yamato M, "MR appearance at different ages of osteoporotic compression fractures of the vertebrae" 16 : 329-334, 1998

22 Kim SW, "Longterm follow-up osteoporotic vertebral fractures according to the morphologic analysis of fracture pattern" 7 : 611-617, 2000

23 Grados F, "Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty" 39 : 1410-1414, 2000

24 Melton LJ 3rd, "Epidemiology of vertebral fractures in women" 129 : 1000-1011, 1989

25 Kim WJ, "Clinical outcome of conservative treatment for osteoporotic compression fractures in thoracolumbar junction" 13 : 240-246, 2006

26 Bengner U, "Changes in incidence and prevalence of vertebral fracture during 30 years" 42 : 293-296, 1988

27 Yamazaki K, "Bone mineral density of the spine and femoral neck fracture in normal japanese subjects using X-ray absoptiometry" 4 : 228-, 1989

28 Cyteval C, "Acute osteoporotic vertebral collapse: open study on percutaneous injection of acrylic surgical cement in 20 patients" 173 : 1685-1690, 1999