| Objective: To compare the clinical effects of percutaneous kyphoplasty,internal fixation with pedical screws and conservative treatment forthoracolumbar compression fractures in the elderly.Methods: From January2009to December2012, a total of92elderlypatients, including52males and40females aged56to85years(with theaverage of64years) with thoracolumbar compression fractures were treatedin the department of Orthopaedics of our hospital. There were9casesfractured at T11,21cases T12,28cases L1,14cases L2,6cases L3,4casesL4, and10cases fractured at double vertebrae. These cases were divided into3groups according to their treatment methods: Group Aof26cases treated bypercutaneous kyphoplasty, Group B of35cases by internal fixation withpedical screws, and Group C of31cases by conservative treatment. The timeof operation, amount of intraoperative bleeding, Cobb’s angle, compressionratio of vertebral body, visual analogue scale (VAS) of pain at the injuredvertebra were observed to evaluate the clinical effects.Results: The average time of operation was45minites in Group A,and 80minites in Group B. The average amount of intraoperative bleeding wasless than50mililiter in Group A, and about300mililiter in Group B. TheCobb’s angles before operation, at1week postoperatively and at1yearpostoperatively were19.8±9.3°,7.9±3.7°and8.4±3.4°respectively in GroupA, while20.4±8.5°,8.2±3.9°,14.5±6.4°in Group B, and20.9±8.4°,14.3±5.6°,24.0±6.6°in Group C. The compression ratios before operation, at1weekpostoperatively and at1year postoperatively were47.1±11.3%,15.8±7.0%and15.4±7.4%respectively in Group A, while48.7±19.5%,16.8±6.9%,24.5±6.4%in Group B, and47.9±15.4%,45.3±15.6%,30.9±6.2%in GroupC。 VAS scores before operation, at1week postoperatively and at1yearpostoperatively were7.1±1.3,1.8±0.8and1.4±0.4respectively in Group A,while7.0±1.5,6.8±2.9,1.5±0.6in Group B, and7.1±1.4,7.3±1.6,1.6±0.5inGroup C.Conclusions:1. PKP can relieve the pain at injured vertebra efficientlyand prevent the postoperative loss of vertebral height and correctional angleseffectively. It is especially indicated for eldly patients of osteoporoticthoracolumbar fractures with poor surgery tolerance.2. Internal fixation withpedical screws can restore the vertebral height and spinal alignment preferably,except for its long time of operation and severe surgical trauma. It can beapplied for those patients suffering from serious vertebral compressionfractures with incomplete vertebral pedical or posterior wall of vertebral body,and even associated with spinal cord or nerve root injury.3. Conservativetreatment is indicated for stable vertebral fractures with minimal compression or those unstable fractures with poor physical condition and intolerant ofsurgery. |
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