应用不同手术方式治疗中老年骨质疏松性胸腰椎爆裂骨折

Outcome analysis of percutaneous kyphoplasty and posterior pedicle screw fixation for senile osteoporosis thoracolumbar burst fractures

[目的]探讨应用不同手术方式治疗中老年骨质疏松性胸腰椎爆裂骨折的可行性并评估其疗效。[方法]对48例中老年骨质疏松性胸腰椎爆裂性骨折患者，根据伤前生活功能状态、影像学检查及术前麻醉风险评估来选择相应不同的手术治疗方法，分为微创组（A组）、内固定组（B组）和内固定结合微创组（C组），评价三组患者手术前后疼痛评分、功能障碍指数、Cobb角变化及并发症发生情况。[结果]所有患者术后获6～38个月（平均21个月）随访。各组术后的疼痛评分、功能评分及Cobb角均较术前明显改善，差异具有统计学意义（P〈0．05）。A组出现骨水泥轻微渗漏3例，相邻椎体再骨折2例；B、C组均未出现内置物松动、脱出等情况，无脊髓神经损伤加重发生。术后根据中华医学会骨科分会脊柱学组腰背痛手术评定标准对手术疗效进行评价，优25例，良19例，可4例，优良率91．6％。[结论]PKP、单纯后路椎弓根内固定和内固定结合PKP技术均是治疗中老年骨质疏松性胸腰椎爆裂骨折可行而有效的方法，根据病人伤前生活功能状态、影像学检查及术前麻醉风险评估来选择相应的治疗方法可获得满意的临床疗效。

[ Objective ] To study the feasibility of surgical interventions in the treatment of senile thoracolumbar burst fracture and evaluate the result. [ Method ] Forty-eight patients with senile thoracolumbar burst fracture from March 2005 to may 2012 were included in this clinical study. According to pre-injury Oswestry disability index, ODI, radiographic examination and preoperative anesthesia risk classification （American Society of Anesthesiologists Association, ASA）, the corresponding different treatment was selected. Surgical treatments were minimally invasive surgery（ group A）and pedicle screw fixation （group B）and transpedicular fixation combined with percutaneous kyphoplasty. Pre-and postoperative functions, symptoms, kyphosis （ Cobb angle） and complications were evaluated for the 3 groups. [ Result] All procedures were performed successfully. The duration of follow-up ranged from 6 to 38 months （mean,21 months）. The visual analog scores （VAS）and functional scores after surgery were statistically improved in group A, B and C （ P 〈 0.05 ）. The difference was statistically significant （ P 〈 0.05 ）. Three cases of minor leakage of bone cement and 2 cases of adjacent vertebral fractures were found in group A. Loosing inside the plant, mobile, spinal cord injury aggravation were not found in group B and C. According to the evaluation criteria of surgical treatment for low back pain, which was established by the Chinese Orthopaedic Association, the result was excellent in 48 patients, good in 25 patients, fair in 19 patients and poor in 4 patients. [ Conclusion ] Percutaneous kyphoplasty （PKP）and open fixation are both ef- fective treatments for elderly osteoporotic thoracolumbar burst fractures. According to the patient~ pre-injury ODI, radiographic examination and preoperative anesthesia risk classification（ ASA）, the appropriate treatment method can obtain satisfactory clinical efficacy. Anti-osteoporosis therapy after surgery with the long-term system is an effective method to prevent the occurrence of osteoporotic thora-lumbar vertebral re-fracture.