[Effect observation of percutaneous pedicle screw fixation combined with percutaneous vertebroplasty for the treatment of osteoporotic thoracolumbar fractures].

OBJECTIVE

To evaluate the clinical effects of percutaneous pedicle screw fixation(PPSF) combined with percutaneous vertebroplasty(PVP) for the treatment of osteoporotic thoracolumbar fractures.

METHODS

The clinical data of 94 patients with osteoporotic thoracolumbar fractures treated from January 2014 to December 2015 were retrospectively analyzed. There were 31 males and 63 females, aged from 65 to 70 years old with an average of 67.2 years. Fracture level was T₁₁ on 15 cases, T₁₂ on 32 cases, L₁ on 29 cases and L₂ on 18 cases. The patients were divided into two groups according to different therapeutic methods. Percutaneous pedicle screw fixation combined with percutaneous vertebroplasty were applied in 43 patients(group A) and percutaneous vertebroplasty was applied to 51 patients(group B). Operation time, intraoperative blood loss, bone cement volume, postoperative in-bed time were recorded; preoperatively, 3 d, 1 year after the operation, the ratios of anterior border heights, sagittal Cobb angles, visual analogue scale(VAS) scores were compared between two groups. The condition of postoperative complication in two groups was analyzed.

RESULTS

All the patients were followed up for 12 to 24 months with an average of 18.5 months. Operation time of group A [(96.2±28.7) min] was longer than that of group B [(31.8±10.6) min]. Intraoperative blood loss of group A[(62.2±25.5) ml] was more than that of group B [(25.4±10.9) ml]. Bone cement volume of group A [(5.5±0.5) ml] was larger than that of group B [(4.9±1.1) ml]. Postoperative in-bed time of group A[(5.1±1.8) d] was longer than that of group B[(1.8±0.7) d]. There were significant differences in operation time, intraoperative blood loss, bone cement volume, postoperative in-bed time between two groups(<0.05). Three days, 12 months after the operation, the ratios of anterior border heights and Cobb angles in two groups were significantly improved. At final follow-up, the ratio of anterior border height and Cobb angle of group A[(85.6±3.5)%, (11.9±5.3)°] were better than of group B[(84.2±4.5)%, (15.3±3.4)°](<0.05). Three cases in group B had re-collapse of cemented vertebral bodies. Postoperative at 3 d, 1 year, VAS score of all patients had significantly decreased(<0.05), and there was no significant difference between two groups(>0.05).

CONCLUSIONS

Compared to simple PVP, PPSF combined with PVP in treating osteoporotic thoracolumbar fracture can obtain stronger vertebral strength and stiffness, furthermore to improve vertebral reduced effect, keeping vertebral heights, and preventing vertebral re-collapse.