골다공증성 압박 골절에서 치료 방법에 따른 새로운 압박 골절의 분석 = Analysis of Treatment Methods for Subsequent Vertebral Fractures Following Osteoporotic Compression Fractures

다국어 초록 (Multilingual Abstract)

Study Design: A multicenter retrospective study.
Objectives: To compare the incidence and pattern of subsequent vertebral fractures following conservative treatment versus vertebroplasty or kyphoplasty for acute osteoporotic vertebral compression fractures.
Summary of Literature Review: Previous studies suggest that new vertebral fractures may increase following vertebroplasty or kyphoplasty because bony cement inserted into the vertebral body of a fractured bone can elevate its strength and stiffness, which in turn, may increase the probability of the compression fractures.
Materials and Methods: From three hospitals, we recruited 135 patients who had been treated for acute osteoporotic compression fractures and had available spine images taken at their 1-year follow-up. The patients were divided into two groups according to treatment methods. Group C had been managed conservatively, and Group VK had undergone vertebroplasty or kyphoplasty. The two groups were compared for subsequent vertebral fractures.
Results: Group C consisted of 76 patients, and Group VK had 59. There were no significant differences between the two groups in terms of age, sex, medical comorbidity, body mass index (BMI), bone mineral density, presence of prior vertebral fracture or acute fracture level (p>0.05). New vertebral fractures were detected in 25 patients (19% of total subjects): 6 (8%) from Group C, and 19 (32%) from Group VK, demonstrating a significantly higher incidence in the VK group (p=0.0007). In the subgroup analysis, there was no significant difference between vertebroplasty and kyphoplasty (p>0.05). While four of the six patients (67%) in Group C had subsequent fractures in nonadjacent vertebrae, 14 of the 19 patients (74%) in Group VK had subsequent fractures in adjacent vertebrae.
Conclusions: Subsequent vertebral fractures were found in 19% of subjects at one year after treatment for acute osteoporotic compression fractures. Compared with conservative treatment, vertbroplasty or kyphoplasty significantly increased the occurrence of subsequent vertebral fractures, which appeared more often in adjacent vertebrae.

국문 초록 (Abstract)

연구 계획: 다기관 후향적 연구.
목적: 본 논문은 골다공증성 압박 골절 후 새롭게 나타나는 압박 골절을 조사, 분석하여 치료 방법에 따른 차이를 알아보고자 하였다.
선행 문헌의 요약: 골다공증성 압박 골절 치료의 한 방법으로 사용되는 경피적 척추 성형술이나 풍선 성형술은 삽입되는 시멘트로 인해 추체의 강도를비정상적으로 증가시켜 새로운 압박 골절을 증가시킬 수 있다는 보고가 있다.
대상 및 방법: 본 연구는 3개의 병원에서 골다공증성 급성 압박 골절에 대한 치료를 시행하고, 1년째 척추 영상을 얻을 수 있었던 환자 135명를 대상으로 후향적으로 조사하였다. 평균 연령은 72.6세(54~92세)이었고 여자는 119명, 남자는 16명이었다. 보존적 치료를 시행한 군과 성형술(척추 성형술 또는 풍선 성형술)을 시행한 군으로 나누어 동반 질환 여부, 체질량 지수(BMI), 골밀도, 급성 압박 골절의 부위, 기존 압박 골절의 유무, 1년째 새롭게 발생된 골절의 발생 빈도 및 부위 등을 조사하였다.
결과: 보존적 치료를 시행한 군은 76명, 성형술을 시행한 군은 59명이었다. 두 군간의 연령, 성별, 동반 질환 여부, BMI, T-score와 골밀도, 급성 압박 골절 부위, 기존 압박 골절의 빈도에는 유의한 차이는 없었다(p>0.05). 1년째 새로운 척추 골절은 총 25명(25/135, 19%)에서 발견되었다. 보존적 치료를시행한 군에서 6명(6/76, 8%), 성형술을 시행한 군에서는 19명(19/59, 32%)에서 발견되어, 성형술에서 시행한 군에서 유의하게 높은 빈도를 보였다(p=0.0007). 성형술을 시행한 군에서 척추 성형술과 풍선 성형술간에는 새로운 척추 골절의 빈도는 유의한 차이가 없었다(p>0.05). 성형술을 시행한 군에서 새로운 골절은 인접 추체에서 발생한 경우(14/19, 74%)가 많았지만, 보존적 치료를 시행한 군에서는 인접 추체가 아닌 추체에서 새로운 골절이 발생한 경우(4/6, 67%)가 많았다.
결론: 골다공증성 압박 골절 후에 1년째 새로운 압박 골절은 19%에서 발생하였다. 척추 성형술이나 풍선 성형술은 보존적 치료보다 새로운 압박 골절의 발생을 유의하게 증가시켰으며, 특히 인접 추체에 높은 빈도로 골절이 발생하였다.

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