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目的探讨治疗骨质疏松性胸腰椎骨折的微创手术治疗方法及临床疗效。方法回顾性分析自2014-06—2015-12诊治的86例骨质疏松性胸腰椎骨折,采用经皮椎体成形术(PVP)治疗43例(50椎,PVP组),采用经皮椎体后凸成形术(PKP)治疗15例(17椎,PKP组),采用经皮椎弓根钉固定并伤椎骨水泥强化术治疗22例(22椎,固定强化组),采用经皮椎弓根钉固定并Quadrant通道下椎管减压治疗6例(6椎,固定减压组)。结果 85例获得随访3~14个月,平均5.2个月。PVP组及PKP组患者年龄较大,伤后至手术时间较长,但手术时间短、术中出血量极少、术后3 d疼痛缓解明显。固定强化组及固定减压组术后伤椎高度恢复、后凸角矫正明显,末次随访时未出现明显椎体高度丢失,术后3个月ODI指数更低。结论微创技术治疗骨质疏松性椎体骨折的疗效取决于选择合适的方案,严格适应证的选择,同时术后正规抗骨质疏松治疗和功能锻炼也是手术取得满意疗效的保证。
Objective To investigate the minimally invasive surgical treatment of osteoporotic thoracolumbar fractures and its clinical effect. Methods 86 cases of osteoporotic thoracolumbar fractures diagnosed and treated from 2014-06-2015-12 were retrospectively analyzed. 43 cases (50 vertebrae and PVP group) were treated with percutaneous vertebroplasty (PVP) Fifteen patients (17 vertebrae and PKP group) underwent kyphoplasty (PKP). Percutaneous pedicle screw fixation and vertebroplasty were used to treat 22 patients (22 vertebrae and fixation group) Nail fixed and quadrant channel decompression under the treatment of 6 cases (6 vertebral, fixed decompression group). Results 85 cases were followed up for 3 to 14 months with an average of 5.2 months. Patients in PVP group and PKP group were older, had longer operation time from injury to injury, but had shorter operation time, minimal intraoperative blood loss and obvious pain relief 3 days after operation. The height of the injured vertebrae was restored in the fixed and fixed decompression groups, and the kyphosis correction was obvious. No significant vertebral height loss occurred at the final follow-up, and the ODI index was lower at 3 months after the operation. Conclusion The minimally invasive treatment of osteoporotic vertebral fractures depends on the choice of appropriate programs, the choice of indications, while regular anti-osteoporosis treatment and functional exercise is also a guarantee of satisfactory surgical results.