经皮与开放椎弓根螺钉内固定治疗胸腰椎骨折对椎旁肌影响的比较

Comparison of the paraspinal muscle change of percutaneous and open pedicle screw fixation in the treatment for thoracolumbar fractures

目的比较经皮与开放椎弓根螺钉内固定技术治疗脊柱胸腰段骨折对椎旁肌的近期、远期的影响。方法 33例胸腰段骨折患者分成近期开放、近期经皮、远期开放、远期经皮手术四组,用椎旁肌针式肌电图及手术前后 CT 椎旁肌面积、色彩级变化研究手术对椎旁肌影响,同时比较远期经皮组、远期开放组患者疼痛、功能评分。结果手术前后四组椎旁肌面积、色彩级变化显著;近期经皮组与近期开放组色彩级变化有显著差异,面积变化无显著差异;远期经皮组与远期开放组色彩级变化无显著差异,面积变化有显著差异。肌电图近期开放组与近期经皮组有显著差异,远期开放组与远期经皮组无显著差异。对患者远期功能评估近期组与远期组无显著差异。结论经皮、开放椎弓根螺钉固定技术均造成椎旁肌损伤,但经皮手术对椎旁肌损伤小于开放手术。

Objectives To compare short-term and long-term change of paraspinal muscle between percutaneous and open pedicle screw fixation in the treatment of thoracolumbar fractures, Methods Thirtythree patients were divided into four groups ： short-term percutaneous pedicle screw fixation group, short-term open pedicle screw fixation group, long-term percutaneous pedicle screw fixation group, and long-term open pedicle screw fixation group. Paraspinal muscle were studied by needle electromyography and CT, Crosssectional area and color grade information of paraspinal muscle were measured using CT image. Results The area and color grade of paraspinal muscle changed significantly after surgery, The color grade of paraspinal muscle showed significant change while the muscle area observed no significant change in the two short-term groups ; There was significant change in paraspinal muscle area, however no significant change was found in muscle color grade of the two long-term groups, In electromyography study the results showed that there was significant difference in the two short-term groups, however no significant difference existed in the long-term groups. There was no significant difference of patients treated by the two surgical technique in long-term function evaluation. Conclusion Both percutaneous and open pedicle screw fixation damage paraspinal muscle, however the muscle showed less injury treated by percutaneous pedicle fixation.