对骨质疏松性压缩骨折的适当使用标准
Charles Cho1, Jeffrey Hills2, Paul Anderson3
1Brigham and Womens Hospital.
概括
这项研究澄清了骨质疏松性脊椎骨折的治疗指示. 医疗管理适用于所有病例,而手术建议用于涉及不稳定性和神经缺陷的特定场景.
科学领域:
- 整形外科 整形外科 整形外科
- 神经外科 神经外科
- 老年病的医生 老年病的医生
背景情况:
- 关于骨质疏松性脊椎骨折的最佳治疗指示存在缺乏共识.
- 澄清这些迹象可以改善患者的治疗结果.
研究的目的:
- 为骨质疏松性脊椎骨折制定多学科治疗建议.
- 北美脊柱学会 (NASS) 的适当使用标准 (AUC) 旨在为各种临床场景定义合理的治疗方法.
主要方法:
- 一个修改后的Delphi过程,基于兰德公司的AUC方法.
- 多学科专家使用九分级评分医疗管理,水泥增强或手术的临床场景.
- 基于共识的评级确定指示为"适当"",不确定"或"很少适当".
主要成果:
- 医疗管理被认为适合所有场景.
- 混凝土增强很少是适当的 (60%) 或不确定的 (35%),在5%的病例中适当使用 (高疼痛,急性骨折).
- 在35%的病例中,手术是适当的,受不稳定性和神经学发现的影响;在18%的病例中,手术很少是适当的,在47%的病例中,手术是不确定的.
结论:
- 使用RAND方法制定了骨质疏松性脊椎骨折的多学科适当治疗标准.
- 这为评估和治疗这些骨折提供了全面的,基于证据的建议.
- 完整的文件可以在NASS网站上找到.
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