中文摘要：

目的比较单纯经皮椎体后凸成形术和经皮内固定联合椎体后凸成形术治疗老年胸腰椎骨质疏松性A3型骨折的疗效。方法2007年1月至2008年12月，43例年龄大于65岁的无神经损伤的胸腰椎骨质疏松性A3型骨折患者随机分为两组，分别采用经皮椎体后凸成形术及经皮内固定联合椎体后凸成形术治疗。术前两组患者的年龄、性别、体重指数、骨折椎节段和骨密度等指标的差异均无统计学意义。术后1周及末次随访时采用疼痛视觉模拟评分和Oswestry功能障碍指数问卷进行疗效评价，摄x线片评估Cobb后凸角矫正度丢失情况。结果全部病例随访24-59个月，平均34．1个月。术后1周及末次随访时疼痛视觉模拟评分：经皮椎体后凸成形术组分别为（2．9±0．8）、（1．4±1．2）分，经皮内固定联合椎体后凸成形术组分别为（0．9±0．6）、（0．4±0．6）分；Oswestry功能障碍指数：经皮椎体后凸成形术组分别为29．2％±8．1％、14．6％±8.4％，经皮内固定联合椎体后凸成形术组分别为17．9％±4．7％、8．1％±5．0％；Cobb角：经皮椎体后凸成形术组分别为7．7°±4．5°、10．4°±4．7°，经皮内固定联合椎体后凸成形术组分别为3．0°±5．8°、4．7°±6．4°。两组差异均有统计学意义。术后经皮椎体后凸成形术组1例发生邻椎骨折，2例发生伤椎再骨折。结论对老年胸腰椎骨质疏松性A3型骨折，经皮内固定联合椎体后凸成形术相对于单纯经皮椎体后凸成形术能更加有效地矫正畸形、缓解疼痛症状、维持伤椎高度及恢复脊柱稳定。

英文摘要：

Objective To compare the therapeutic effect of percutaneous kyphoplasty alone and percutaneous pedicle instrumentation combined with percutaneous kyphoplasty for osteoporotic type-A3 thoracolumbar fractures in elderly patients. Methods From January 2007 to December 2008, 43 patients older than 65 years with osteoporotic type-A3 thoracolumbar fracture without nerve damage were randomly divided into two groups： pereutaneous kyphoplasty alone group （1） and percutaneous pedicle instrumentation combined with percutaneous kyphoplasty group （2）. Then percutaneous kyphoplasty and percutaneous pedicle instrumentation combined with percutaneous kyphoplasty were performed in patients of each group, respectively. Before operation, there were no statistical differences in many parameters between two groups, such as age, gender, body mass index, affected segments and bone density. Results All patients were followed up for 24 to 59 months （average, 34.1 months）. One week after operation, visual analogue scales （VAS）, Oswestry disability index （OD1） and Cobb angle were respectively 2.9±0.8, 29.2%±8.1% a nd 7.70±4.5° in group 1, and 0.9±0.6, 17.9%±4.7% and 3.00±5.8° in group 2. At final follow-up, VAS score, ODI and Cobb angle were respectively 1.4±1.2, 14.6%±8.4% and 10.4°±4.7° in group 1, and 0.4±0.6, 8.1%±5.0% and 4.70±6.4°in group 2. There were significant differences between two groups at two time points. In percutaneous kyphoplasty alone group, adjacent vertebral fracture occurred in 1 patient, and vertebral refracture in 2 patients. Conclusion For elderly patients with osteoporotic type-A3 thoracolumbar fracture, compared with percutaneous kyphoplasty alone, percutaneous pedicle instrumentation combined with percutaneous kyphoplasty is more effective in correcting deformity, relieving pain, maintaining vertebral height and restoring spinal stability.