经皮椎弓根固定联合椎体成形术治疗胸腰椎骨质疏松性骨折

Percutaneous pedicle screw fixation combined with kyphoplasty for treatment of osteoporotic thoracolumbar fracture

[目的]探讨经皮椎弓根内固定联合椎体后凸成形术在治疗胸腰椎骨质疏松性压缩骨折中的应用。[方法]2014年12月~2016年5月在本院就诊的骨质疏松性胸腰椎骨折患者106例,随机分为经皮椎弓根内固定联合椎体后凸成形术治疗组(联合组)和单纯经皮椎体后凸成形术治疗组(对照组),联合组54例,对照组52例,所有患者均为单椎体,于术前、术后和末次随访采用视觉疼痛模拟量表(VAS)、Oswestry功能障碍指数(ODI)、Cobb角及椎体前缘高度压缩率评定临床效果。[结果]所有患者顺利完成手术,均获随访,时间15~19个月。术前两组患者VAS评分、ODI指数、Cobb角度变化及椎体前缘高度压缩率的差异均无统计学意义(P>0.05),但末次随访时,联合组上述指标数值均小于对照组,组间比较差异有统计学意义(P<0.05)。[结论]经皮椎弓根内固定联合椎体后凸成形术治疗胸腰椎骨质疏松性压缩骨折创伤小,可以更好地恢复脊柱稳定性,有效维持伤椎的形态完整及强度、高度,从而减轻疼痛,提高患者生存质量。

[Objective] To investigate the outcome of percutaneous pedicle screw fixation combined with kyphoplasty for osteoporotic thoracolumbar fractures. [Method] From December 2014 to May 2016, 106 patients with osteoporotic thora, columbar fractures were enrolled and randomly divided two groups. Percutaneous pedicle screw fixation combined with kypho- plasty was carried out in 54 patients as the combined group, while the other 52 patients in the control group received percutaneous kyphoplasty only. The clinical outcome was assessed by using visual pain analogue scale （VAS）, Oswestry dysfunction index （ODI）, Cobb angle and anterior vertebral compression rate before surgery and at the final follow-up. [Results] All patients, who had a successful operation, were followed up for 15-19 months. No significant differences were noted between the two groups before operation in VAS, ODI, Cobb angle and anterior vertebral compression rate （P〉0.05）. However, the combined group was significantly less than the control group in aforesaid parameters at the latest follow up （P〈0.05）, which meant the for, mer was superior to the latter in clinical outcome. [Conclusion] For treatment of osteoporotic thoracolumbar fractures, thepercutaneous pedicle screw fixation combined with kyphoplasty with advantages of less trauma, better restoration of the spinal stability and morphological integrity, does effectively reduce oain and improve qualitv of patient life.