骨質疏鬆脊椎壓迫性骨折造成的疼痛－－回顧病因及現行保守治療

Osteoporotic vertebral compression fracture-related pain: Review of causes and treatments

根據世界衛生組織統計，因骨質疏鬆引起的壓迫性骨折發生率最高的部位就是脊椎，並且好發於年長的患者，50歲以上患者約8%，而65歲以上患者約27%。骨鬆引起的脊椎壓迫性骨折會造成脊椎塌陷，脊柱變形，腹腔及胸腔空間變小併發肺功能減少而導致病患行動受限及心理上的憂慮。統計上更指出脊椎壓迫性骨折患者其4年及5年的死亡率遠遠超過髖部骨折的患者。目前治療上以保守治療及侵略性的骨折重建手術治療為主，而其兩者目的皆為減輕病患疼痛及恢復患者行動功能為主。脊椎重建手術以椎體骨泥整形術(vertebroplasty)，和椎體成形術(Kyphoplasty)為主，兩者皆提供了較不侵略性的手術治療。近期的研究報告對這兩種的治療成效提出質疑，而此篇文章的目的即是探討現今的研究及文獻，而針對於目前骨質疏鬆造成的疼痛治療提出其利弊及成效。結論：骨質疏鬆引起的脊椎壓迫性骨折可能引起嚴重疼痛並且影響日常生活。目前對於疼痛的治療方式主要是保守性治療如藥物、物理治療及背架使用，若是持續疼痛可以考慮較為侵略性的脊椎重建手術如椎體骨泥整形術和椎體成形術，目前證據顯示相較於保守治療有較好的短期療效，仍需要更多臨床研究來證實長期的結果。

Osteoporosis, which is a systemic disorder, which is painless by definition. However, it resulted in pain and worsen life quality by lowering bone density that leads to fragile bones and higher fractures risks. Osteoporotic vertebral compression fractures (OVCFs) are common cause of back pain and deformity in the elderly which constitute a major health problem worldwide. It is estimated that OVCF will develop in 8 % of women older than 50 years and 27 % of men and women older than 65 years. OVCF results in loss of anterior vertebral height and causes spinal deformities. Beside the pain, it also reduced pulmonary function, restriction of the abdominal and thoracic contents, impaired mobility and clinical depression. Both 4-and 5-year mortality rates in patients with compression fractures in their thoracic or lumbar spine exceeded those of patients suffering from hip fractures.　Treatment options range from conservative treatment to decrease pain and increase bone density to invasive, reconstructive surgeries. Vertebral augmentation procedures such as vertebroplasty and kyphoplasty, offer far less invasive alternatives to open-spine surgery for pain control and prevent deformity progression. The objective of the article was to review the current research about the etiology and biomechanical point of view of the OVCF and the current treatment options. In conclusion, vertebral compression fractures are the most common type of osteoporotic fractures and may cause severe pain that disturb daily activity. Treatment options range from conservative treatment to invasive, reconstructive surgery such as vertebroplasty and kyphoplasty. Evidence suggests that physical disability, general health, and pain relief are better with vertebroplasty and kyphoplasty than those with medical management within the first 3 months after intervention. We need more high-quality randomized trials to confirm its benefit compared with medical treatment.