Objective To observe clinical effects of pedicle screw fixation (PSF) and percutaneous kyphoplasty(PSP) in the treatment of osteoporotic thoracolumbar fracture.Methods Totally 94 cases of osteoporotic thoracolumbar fracture from August 2011 to February 2015 in People's Hospital Affiliated to Hubei University of Medicine were randomly divided into observation group and control group,with 47 cases in each group.The control group was treated with PSF,the observation group was treated with PSP.Operation duration,intraoperative blood loss,bone-grafting mass and length of hospital stay were recorded.After 3 months,height of vertebral leading edge and Frankle neural function rank were analyzed.Adverse reactions were observed.Results In the observation group,operation duration,intraoperative blood loss,bone-grafting mass and length of hospital stay were significantly less than those in control group [(92 ± 10) min vs (115 ± 13) min,(114 ± 19) ml vs (167 ± 22) ml,(7.2 ±0.4) ml vs (9.2 ± 0.7) ml,(11.5 ± 2.6) d vs (17.0 ± 3.1) d] (P ＜ 0.05).Preoperative vertebral heights and Frankle ranks had no significant difference between groups(P ＞ 0.05).After 3 months,vertebral heights were significantly higher than those before operation in the both groups [observation group:(93 ± 7) ％ vs (67 ± 7) ％;control group:(87 ± 6) ％ vs (68 ± 7) ％] (P ＜ 0.05),and vertebral height in observation group was significantly higher than that in control group(P ＜ 0.05);Frankle ranks in the both groups were significantly better than those before operation;the Frankle rank in observation group was significantly better than that in control group(all P ＜ 0.05).The incidence of adverse reactions in observation group was significantly lower than that in control group [4.3％ (2/47) vs 21.3％ (10/47)] (P ＜0.05).Conclusion PSP is safer and more effectiveness than PSF in the treatment of osteoporotic thoracolumbar fracture.%目的 比较经皮穿刺椎体后凸成形术与椎弓根螺钉固定治疗骨质疏松性胸腰椎骨折的临床效果.方法 选取2011年8月至2015年2月在湖北医药学院附属人民医院诊治的骨质疏松性胸腰椎骨折患者94例,根据随机数字表法分为观察组与对照组,各47例.观察组给予经皮穿刺球囊扩张椎体后凸成形术,对照组给予椎弓根螺钉固定.比较2组手术时间、术中出血量、植骨量和住院时间.比较2组术前和术后3个月的椎前缘高度和Frankle神经功能评估分级及术后3个月不良反应发生情况.结果 观察组手术时间、术中出血量、植骨量和住院时间均明显少于对照组[(92 ±10)min比(115±13)min、(114±19)ml比(167±22)ml、(7.2±0.4)ml比(9.2±0.7)ml、(11.5±2.6)d比(17.0±3.1)d],差异均有统计学意义(均P＜0.05).2组术前椎前缘高度比较,差异无统计学意义(P＞0.05),术后3个月,2组椎前缘高度均明显高于术前[观察组:(93±7)％比(67±7)％;对照组:(87±6)％比(68±7)％],且观察组明显高于对照组,差异均有统计学意义(均P＜0.05).2组患者术前Frankle分级比较,差异无统计学意义(P＞0.05),术后3个月Frankle分级均明显好于术前,且观察组明显好于对照组,差异均有统计学意义(均P＜0.05).观察组不良反应发生率明显低于对照组[4.3％ (2/47)比21.3％ (10/47)],差异有统计学意义(P＜0.05).结论 相对于椎弓根螺钉固定,经皮穿刺椎体后凸成形术治疗骨质疏松性胸腰椎骨折能促进椎体高度和脊髓神经功能的恢复,具有很好的微创性与安全性.
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