周疆 王琳

【摘要】 目的：探討经皮椎体后凸成形术与联合内固定在胸椎或/和腰椎骨质疏松性骨折的治疗中可达到何种临床效果。方法：将67例腰椎骨质疏松性骨折患者按照随机数字表法分为经皮椎体后凸成形术与联合内固定组（n=36）和椎体后凸成形术组（n=31），椎体后凸成形术组行椎体后凸成形术治疗，经皮椎体后凸成形术与联合内固定组行经皮椎体后凸成形术与联合内固定治疗，在手术治疗之后随访6个月，比较两组患者手术过程中情况及在手术治疗后3次观察时患者疼痛得分、Cobb角、丢失椎体前缘高度发生的变化。结果：经皮椎体后凸成形术与联合内固定组手术全程所花费时间、术中出血量、注入骨水泥总量均高于椎体后凸成形术组，差异均有统计学意义（P<0.05），骨水泥渗漏发生率低于椎体后凸成形术组，差异有统计学意义（P<0.05）；在手术治疗后随访6个月，两组患者平均VAS得分、Cobb角、丢失椎体前缘高度均低于手术治疗前，差异均有统计学意义（P<0.05）；经皮椎体后凸成形术与联合内固定组在手术治疗后1周、在手术治疗后1个月及在手术治疗后6个月的Cobb角、平均VAS得分、丢失椎体前缘高度均显著低于椎体后凸成形术组，差异均有统计学意义（P<0.05）。结论：经皮椎体后凸成形术与联合内固定可以有效地减轻患者疼痛，恢复脊柱稳定性及维持受损伤的椎体高度。

【关键词】 胸椎或/和腰椎骨质疏松性骨折； A3型骨折； 经皮内固定； 椎体后凸成形术

doi：10.14033/j.cnki.cfmr.2018.7.001 文献标识码 A 文章编号 1674-6805（2018）07-0001-03

【Abstract】 Objective：To investigate the effect of percutaneous kyphoplasty alone and percutaneous pedicle instrumentation combined with percutaneous kyphoplasty for thoracolumbar osteoporotic fractures.Method：A Total of 67 patients with vertebral osteoporotic fracture patients were randomly divided into percutaneous kyphoplasty and combined internal fixation group（n=36） and kyphoplasty group（n=31），the kyphoplasty group was given the treatment of percutaneous kyphoplasty，the percutaneous kyphoplasty and combined internal fixation group was given the treatment of percutaneous pedicle instrumentation combined with percutaneous kyphoplasty.The operation condition and the pain degree， Cobb angle， anterior vertebral height loss variation were compared between the two groups of patients at different time.Result：The Percutaneous kyphoplasty and combined internal fixation group operation time， bleeding volume， bone cement injection volume was higher than that of Kyphoplasty group （P<0.05），the bone cement leakage rate was lower than that of the Kyphoplasty group（P<0.05）.The postoperative follow-up of 6 months，two groups of patients with VAS score，Cobb angle，anterior vertebral height loss were lower than that before operation （P<0.05），the percutaneous kyphoplasty and combined internal fixation group after 1 week，1 month after operation，6 months after surgery，VAS score，Cobb angle，anterior vertebral height loss was lower than the kyphoplasty group （P<0.05）.Conclusion：Percutaneous pedicle instrumentation combined with percutaneous kyphoplasty can effectively reduce the pain of patients， to restore the stability of spine and maintain the height of vertebral injury.

【Key words】 Thoracolumbar osteoporotic fractures； Type A3 fracture； Percutaneous pedicle instrumentation； Percutaneous kyphoplasty

First-authors address：Shanghai University of Sport Injury Orthopedic Hospital，Shanghai 201438，China

胸椎或/和腰椎骨质疏松性骨折是老年群体中常见骨折类型，随年龄增长机体骨质逐渐流失，骨的质量及强度下降，当受到高能量打击时，极易发生胸椎或/和腰椎骨折。目前，治疗胸椎或/和腰椎骨质疏松性骨折的术式较多，但部分患者经治疗后虽然患者的疼痛得分得到缓解，不过腰椎节段稳定性未得到有效缓解和控制，依然伴有长期疼痛，而个别患者甚至出现进行性加重或迟发性神经症状，影响患者生活质量及预后[1]。为探讨胸椎或/和腰椎骨质疏松性骨折有效的治疗方式，本研究对36例胸椎或/和腰椎骨质疏松性骨折患者采用了经皮椎体后凸成形术与联合内固定治疗，效果比较满意。……