经皮球囊扩张椎体后凸成形术与经椎弓根螺钉内固定术治疗老年性胸腰椎压缩性骨折的临床效果

Clinical efficacy of percutaneous kyphoplasty and pedical-screw internal fixation treating vertebral compression fractures in elderly patients

目的探讨经皮球囊扩张椎体后凸成形术（PKP）与切开复位经椎弓根螺钉内固定术治疗老年性胸腰椎压缩性骨折的临床效果。方法收集2010年1月至2015年4月于江苏省昆山市第四人民医院和苏州大学附属第一医院住院治疗的32例老年性胸腰椎压缩性患者的病历资料，根据手术治疗方法的不同分为PKP组和经椎弓根螺钉内固定术组，各16例。对手术时间、术后下床时间、手术前后伤椎后凸畸形角度（Cobb’s角）、伤椎椎体压缩率、疼痛视觉模拟量表（VAS）评分及并发症发生情况进行统计学分析。结果PKP组手术时间及术后下床时间均明显短于经椎弓根螺钉内固定术组[（45．0±1．3）min比（80．0±3．3）min，（2．09±0．18）d比（64．00±27．00）d]（P〈0．05）。术前2组Cobb’s角、椎体压缩率及VAS评分差异均无统计学意义（P〉0．05）。术后1周和12个月时，PKP组的Cobb’s角及椎体压缩率均明显低于经椎弓根螺钉内固定术组[术后1周：（7±4）°比（9±4）°，（15±7）％比（17±7）％；术后12个月：（9±4）°比（15±7）°，（15±7）％比（24±5）％]（P〈0．05）。术后1周时，PKP组的VAS评分明显低于经椎弓根螺钉内固定术组[（1．7±0．7）分比（7．0±2．1）分]（P〈0．05）。2组均无并发症发生。结论PKP可迅速缓解老年性胸腰椎压缩性骨折患者的疼痛，可有效预防术后伤椎椎体高度和矫正角度的丢失。

Objective To explore clinical effects of percutaneous kyphoplasty （PKP） and pedical-screw internal fixation on elderly patients with thoracic and lumbar vertebral compression fractures. Methods Totally 32 elderly patients with thoracic and lumbar vertebral compression fractures from January 2010 to April 2015 in Kunshan No. 4 People＇s Hospital and the First Affiliated Hospital of Soochow University were divided into PKP group and pedical-screw internal fixation group, with 16 cases in each group. Operation time, postoperative off-bed time, Cobb＇s angle, vertebral compression ratio, pain visual analogue scale （VAS） score and complication occurrence were analyzed. Results Operation time and postoperative off-bed time in PKP group were significantly shorter than those in pedical-screw internal fixation group [ （45.0 ± 1.3 ） min vs （ 80. 0 ± 3.3 ） min, （ 2. 09 ± 0. 18） d vs （64. 00 ± 27.00） d ] （ P 〈 0. 05 ）. Before operation, Cobb＇ s angles, vertebral compression ratio and VAS score had no significant difference between groups （P 〉 0. 05 ）. One week and 12 months after operation, Cobb＇s angles and vertebral compression ratio in PKP group were significantly lower than those in pedical-screw in- ternal fixation group[ 1 weeks after operation： （7 ±4）° vs （9 ±4）°,（15 ±7）% vs （17 ±7）% ;12 months after operation ： （9 ± 4） ° vs （ 15 ± 7 ） °, （ 15 ± 7 ） % vs （ 24 ± 5 ） % ] （ P 〈 0. 05 ）. One week after operation, VAS scores in PKP group were significantly lower than those in pedical-screw internal fixation group [ （ 1.7 ± 0. 7）scores vs （7.0 ± 2. 1 ） scores ] （P 〈 0.05 ）. There were no postoperative complications in both groups. Conclusion PKP operation can significantly alleviate pain in elderly patients with vertebral compression fractures; it can alsoeffectively prevent the loss of vertebral height and corrective angle after operation.