目的 比较单纯椎弓根螺钉内固定术和经皮球囊扩张椎体后凸成形术(percutaneous kypho-plasty,PKP)联合椎弓根螺钉内固定术治疗老年骨质疏松性胸腰段脊柱爆裂性骨折的临床疗效.方法 选取2013年7月至2016年7月,我院收治的300例老年骨质疏松性胸腰段脊柱爆裂性骨折患者为研究对象,按入院顺序编号后采用随机数字表法分为观察组、对照组各150例,对照组实施椎弓根螺钉内固定术,观察组行PKP联合椎弓根螺钉内固定术,术后随访1年,对比两组手术时间、术中失血量、术后引流量及疗效优良率,记录两组术后1周、6个月、1年疼痛视觉模拟评分(visual analogue scale,VAS)、Beaujon-Lassale功能评分及脊柱后凸畸形Cobb's角、椎体前后缘高度比,并观察并发症.结果 观察组手术时间(132.19±1.89)min、术中失血量(255.49±1.54)ml与对照组(124.29±1.05)min、(231.23±1.67)ml比较明显增多,差异有统计学意义(P<0.05),两组术后引流量对比差异无统计学意义(P>0.05);观察组术后1年疗效优良率94.00%高于对照组86.67%,差异有统计学意义(P<0.05);术后6个月、1年观察组VAS评分[(2.16±0.12)分、(1.56±0.21)分]低于对照组[(2.35±0.12)分、(1.87±0.18)分],Beaujon-Lassale功能评分[(18.75±0.44)分、(19.54±0.16)分]高于对照组[(17.58±0.44)分、(18.12±0.41)分],差异均有统计学意义(P<0.05);术后6个月、1年观察组Cobb's角[(12.14±1.03)°、(9.78±1.23)°]小于对照组[(15.12±1.15)°、(11.15±0.78)°],而椎体前后缘高度比[(80.66±1.13)°、(86.38±1.09)°]大于对照组[(78.56±1.27)°、(83.10±1.75)°](P<0.05);术后1年观察组并发症发生率8.67%明显低于对照组18.00%,差异有统计学意义(P<0.05).结论 PKP联合椎弓根螺钉内固定术治疗老年骨质疏松性胸腰段脊柱爆裂性骨折的近期疗效与椎弓根螺钉内固定术相近,PKP联合内固定术后患者疼痛度、脊柱功能在远期改善更好,术后并发症少,值得在临床推广实践.%Objective To compare the clinical effects of simple pedicle screw fixation and percutaneous kyphoplasty ( PKP ) combined with pedicle screw fixation in the treatment of senile osteoporotic thoracolumbar burst fractures.Methods 300 elderly patients with osteoporotic thoracolumbar burst fractures, treated in our hospital from July 2013 to July 2016, were selected. They were numbered according to the order of admission and then were randomly divided into the observation group (n= 150 ) and the control group (n= 150 ). The control group was treated by pedicle screw fixation, while the observation group was treated by PKP combined with pedicle screw ifxation. All were followed up for 1 year after operation. The operation time, intraoperative blood loss, postoperative drainage volume and the excellent and good rate were compared between the 2 groups. The visual analogue scale ( VAS ), Beaujon-Lassale function, kyphosis Cobb's angle and the ratio of anterior and posterior vertebral height in the 2 groups were recorded at 1 week, 6 months and 1 year after operation. The complications were observed.Results The operation time and intraoperative blood loss of the observation group [ ( 132.19 ± 1.89 ) min and ( 255.49 ± 1.54 ) ml ] were longer / more than that of the control group [ ( 124.29 ± 1.05 ) min and ( 231.23 ± 1.67 ) ml ] (P < 0.05 ), but there were no signiifcant differences in postoperative drainage volume between the 2 groups (P> 0.05 ). The excellent and good rate in the observation group 1 year after operation was higher than that in the control group ( 94.00%vs.86.67% ) (P < 0.05 ). The VAS scores of the observation group 6 months and 1 year after operation [ ( 2.16 ± 0.12 ) points, ( 1.56 ± 0.21 ) points ) ] were lower than that of the control group [ ( 2.35 ± 0.12 ) points, ( 1.87 ± 0.18 ) points ], while the Beaujon-Lassale function scores [ ( 18.75 ± 0.44 ) points, ( 19.54 ± 0.16 ) points ] were higher than that of the control group [ ( 17.58 ± 0.44 ) points, ( 18.12 ± 0.41 ) points ] ( P< 0.05 ). The Cobb's angles in observation group 6 months and 1 year after operation [ ( 12.14 ± 1.03 ) degrees, ( 9.78 ± 1.23) degrees ] were smaller than that of the control group [ ( 15.12 ± 1.15 ) degrees, ( 11.15 ± 0.78 ) degrees ], while the ratio of anterior and posterior vertebral height [ ( 80.66 ± 1.13 ) degrees, ( 86.38 ± 1.09 ) degrees ] were larger than that in the control group [ ( 78.56 ± 1.27 ) degrees, ( 83.10 ± 1.75 ) degrees ] (P < 0.05 ). The incidence rate of complications in the observation group 1 year after operation was signiifcantly lower than that in the control group ( 8.67%vs. 18.00% ) (P< 0.05 ).Conclusions The short-term effects of PKP combined with pedicle screw ifxation are similar to that of the pedicle screw ifxation in the treatment of osteoporotic thoracolumbar burst fractures. PKP combined with internal ifxation can better relieve patients' pain and improve their spinal functions, with fewer postoperative complications.
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