| Objective: to compare the efficacy and feasibility of PVP combined with percutaneous internal fixation and PKP in the treatment of single segment osteoporotic thoracolumbar A3 fractures without nerve injury in the elderly,and to provide some reference for clinical treatment.Methods: the clinical and imaging data of 40 patients with thoracolumbar osteoporotic A3 fractures without nerve injury in the Department of Spinal surgery,the second affiliated Hospital of da lian medical University from September 2015 to March 2018 were analyzed retrospectively.There were 20 cases in PVP combined with percutaneous internal fixation group and 20 cases in PKP group.The preoperative general data,operation time,intraoperative blood loss,bone cement injection volume,total hospitalization time,spinal canal occupation rate,anterior and middle edge compression rate,VAS score and Cobb angle were recorded in the two groups.Results: all patients were followed up effectively for 12-20 months.The operative time,intraoperative blood loss and bone cement injection in PVP combined with percutaneous internal fixation group were higher than those in PKP group(P < 0.05),but there was no significant difference in hospital stay between the two groups(P >0.05).The preoperative observation indices of the two groups were comparable(P >0.05).There was no significant difference in VAS score between the two groups after operation and at the last follow-up(P > 0.05).The space occupying rate of spinal canal,the compression ratio of anterior and middle edge of vertebral body and the angle of Cobb in PVP combined with percutaneous internal fixation group were lower than those in PKP group after operation and the last follow-up(P < 0.05).In PKP group,there was no significant improvement in spinal canal space occupying rate after operation(P > 0.05),but the last follow-up was more effective than that before and after operation(P < 0.05).The space occupying rate of spinal canal in PVP combined with internal fixation group was significantly improved after operation and at the last follow-up(P < 0.05),and the last follow-up was still statistically significant compared with that after operation.The VAS score,Cobb angle,compression ratio of anterior and middle edge of vertebral body in both groups were lower than those before operation(P< 0.05),In PVP combined with percutaneous internal fixation group,bone cement leakage occurred in 6 cases,leakage to paravertebral soft tissue in 2 cases,leakage to vertebral vein in 2 cases,leakage to intervertebral disc in 1 case,leakage to anterior vertebral body and intervertebral disc in 1 case,but no clinical symptoms were found.In PKP group,bone cement leakage occurred in 8 cases,leakage to intervertebral disc in 2 cases,leakage to paravertebral soft tissue in 3 cases,leakage to vertebral vein in 2cases,leakage to anterior vertebral body and disc in 1 case,and no clinical symptoms were found.No bone cement pulmonary embolism was found by chest X-ray after operation in both groups.In the PVP combined with percutaneous internal fixation group,there were no complications such as loosening and fracture of internal fixation,prolapse,recurrent fracture of injured vertebrae and adjacent vertebrae.In PKP group,there were 2 cases of fracture,both of which were adjacent to the vertebral body,and were treated with PKP again.Conclusion: 1.PVP combined with percutaneous internal fixation and PKP is an effective and feasible method for the treatment of osteoporotic thoracolumbar A3 fractures with selective single segment spinal canal occupation in the elderly,but it is necessary to strictly grasp the technique and key points of intraoperative bone cement filling.Avoid catastrophic consequences of bone cement spinal canal leakage.2.Although the operation time and intraoperative blood loss in PVP combined with percutaneous internal fixation group were slightly more than those in PKP group,compared with open surgery,trauma,bleeding and hospitalization time were significantly reduced,which were easy for patients to accept.3.Compared with PKP,PVP combined with percutaneous internal fixation can better restore the height of vertebral body,correct kyphosis,reduce the loss of correction,maintain spinal stability and reduce the space occupying rate of spinal canal.The amount of bone cement injection in PVP combined with percutaneous internal fixation group was more than that in PKP group,but the number of bone cement leakage was not increased.The rate of recurrent fracture of injured vertebrae and adjacent vertebrae in PVP combined with percutaneous internal fixation group was lower than that in PKP group,although there was no significant difference between the two groups.To sum up,PVP combined with percutaneous internal fixation is recommended for selective single segment osteoporotic thoracolumbar A3 fractures with high correction requirements,severe compression and severe spinal canal space occupying rate in the elderly.on the contrary,PKP is recommended. |
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