骨粗鬆症性脊椎圧迫骨折の自然経過―外固定なしで予後良好な症例の検討

Natural History of Osteoporotic Vertebral Compression Fractures

　有痛性骨粗鬆症性椎体圧迫骨折に対しギプスや硬性コルセットでの外固定を施行しなかった68例について，経時的に自然経過を1年間調査した．臨床的およびX線学的な総合評価において初診時椎体楔状率が高いほど予後は良好であったが，高骨密度，胸椎部損傷や椎体後壁が保たれている場合でも外固定なしでは圧壊や癒合不全に陥り，疼痛や機能障害が残存する症例があった．受傷後1カ月までの経過観察が重要と考えられた．

　This report describes the results of follow-up examinations a minimum of 1 year after the onset of osteoporotic vertebral compression fractures (OVCFs) as a means of investigating the natural history of OVCF. After excluding patients treated with a custom-molded orthosis and cast, the 68 remaining patients with a painful OVCF were enrolled in this study. Outcome was evaluated clinically and radiographically. A factor analysis for good outcome of OVCF was performed. A logistic regression analysis revealed that good clinical and radiographic outcome was independently associated with the kyphosis rate at the time of the initial examination. The results of this study of the natural history of OVCF showed that the clinical and radiographic outcome was often poor. The clinical and radiographic 1-month follow-up examination is important for the determination of the prognosis of OVCF.