经皮内固定联合椎体后凸成形术治疗老年胸腰椎骨质疏松性A3型骨折的疗效观察

The therapeutic effect of percutaneous fixation combining with percutaneous kyphoplasty on type A3 senile osteoporotic thoracolumbar fracture

目的 比较经皮内固定联合椎体后凸成形术与经皮椎体后凸成形术治疗老年胸腰椎骨质疏松性A3型骨折的疗效。方法 选择2010年1月-2010年12月收治的老年胸腰椎骨质疏松性A3型骨折患者56例,采用随机数字表法分为2组,联合组28例采用经皮内固定联合椎体后凸成形术治疗,对照组28例患者采用经皮椎体后凸成形术治疗,比较2组手术时间、出血量、注入骨水泥量、疼痛评分等相关指标以及近远期疗效。结果 联合组平均手术时间（95.6±11.7）min、术中出血量（51.5±12.5）ml,注入骨水泥量（4.75±0.99）ml,均优于对照组（34.7±9.3）min、（11.6±1.7）ml、（4.16±0.54）ml,2组比较差异具有显著性（P〈0.05）。2组术后下床时间、平均住院时间比较差异无显著性（P〉0.05）。随访3~24个月,2组术后VAS疼痛评分、术后Cobb＇角和椎体前缘丢失高度明显低于术前,术后6个月、12个月、24个月联合组VAS疼痛评分、术后Cobb＇角和椎体前缘丢失高度均低于对照组,2组比较差异具有显著性（P〈0.05）。结论 经皮内固定联合椎体后凸成形术可以更好地恢复脊柱稳定,有效维持伤椎高度,从而减轻疼痛,提高患者生存质量。

Objective To observe the therapeutic effect of percutaneous fixation combined with percutaneous kyphoplasty on aged osteoporotic thoracolumbar A 3 fractures.Methods From January 2010 to December 2010, 56 patients with aged osteoporotic thoracolumbar A 3 fractures were enrolled , using random digital table , they were divided into 2 group, combined group of 28 cases received percutaneous fixation combined with percutaneous kyphoplasty treatment , 28 patients in the control group using percutaneous kyphoplasty treatment , compare the efficacy of 2 groups ’ operation time , bleeding volume , injection of bone cement volume index , pain score and the short term and long term .Results Combined group ’ s average operation time （95.6 ±11.7） min, amount of bleeding during operation （51.5 ±12.5） ml, injected cement volume （4.75 ± 0.99） ml were better than the control group （34.7 ±9.3） min, （11.6 ±1.7） ml, （4.16 ±0.54） ml, the differences between the 2 groups was significant （ P 〈0.05）.Two groups’ postoperative ambulation time, average hospitalization time revealed no significant difference （ P 〉0.05）.The follow-up were 3-24 months, 2 groups’ postoperative VAS pain score, postoperative Cobb angle and the anterior vertebral height loss was significantly lower than preoperative ; postoperative 6 month, 12 months, 24 months, in combined group, the VAS pain score, postoperative Cobb angle and the anterior vertebral height loss was lower than the control group , the differences was significant （ P 〈0.05）.Conclusion It demonstrated that the percutaneous fixation combined with percutaneous kyphoplasty could better restore the spinal stability , effectively maintain the height of vertebral injury , so as to reduce pain , improve quality of life of the patients .