经椎旁肌间隙入路在胸腰椎骨折治疗中的应用

Paraspinal muscle approach in the treatment of thoracic and lumbar spine fractures

目的探讨经椎旁肌间隙入路治疗胸腰椎骨折的手术方法及其与传统手术方法的比较。方法2006年10月至2008年10月，52例无神经损伤表现的胸腰椎骨折患者被纳入研究。依据Denis骨折分型，压缩型骨折17例，爆裂型骨折35例，其中男37例，女15例；年龄18-59岁，平均46．5岁。T4骨折1例，T7骨折2例，T8骨折1例，T10骨折3例，T11骨折5例，T13骨折14例，L1骨折16例，L2骨折9例，L3骨折1例。影像学检查示：椎管内占位〈1／3，突人椎管骨块均匀完整，无碎裂及翻转。患者依次纳入研究，分为两组，其中20例患者采用传统后正中入路，其他32例患者采用经椎旁肌间隙人路，均行后路椎弓根螺钉固定。结果两组患者在性别、年龄、损伤节段、受伤至手术时间及随访时间方面比较，差异均无统计学意义。经肌间隙入路较传统后正中入路在手术时间、术中出血量、引流放置时间、术后引流量、术后下地时间，疼痛视觉模拟评分及Oswestry功能障碍指数等方面具有显著优势，两组间比较各项指标差异均有统计学意义。至2009年10月，所有患者均获得随访，平均时间21．5个月（12-36个月），所有患者伤椎椎体高度均无丢失，内固定无松动、断裂。结论与传统手术方法相比，经椎旁肌间隙入路治疗胸腰椎骨折可完整保留脊柱后方复合体结构，具有创伤小、出血少和恢复快等优点，是一种安全实用的手术方法，疗效满意。

Objective To evaluate the posterior paraspinal muscle approach in the treatment of tho- racic and lumbar spine fractures and compare this method with the conventional approach. Methods From October 2006 to October 2008, a total of 52 cases of non-neurological symptoms patients with thoracic and lumbar spine fractures were included in the study, including 37 males and 15 females with an average of 46.5 years （range, 18-59 years）. According to the Denis fracture classification, there were 17 compression fractures and 35 burst fractures with spinal space-occupying less than 1/3, including 1 case with T4 fracture, 2 with T7 fracture, 1 with Ts fracture, 3 with T10 fracture, 5 with T. fracture, 14 with T,2 fracture, 16 with L1 fracture, 9 with L2 fracture, and 1 with L3 fracture. The patients were divided into two groups, with 20 cases treated with the traditional approach and the other 32 cases with the posterior paraspinal muscle approach. All the patients were given pedicle screw fixation. Results No significant differences were found in terms of gender, age, injured segment, operation time and follow-up period between the two groups. Compared to the traditional approach, the posterior paraspinal muscle approach was significantly advantageous in terms of time, the amount of bleeding, postoperative drainage, duration of recumbence, pain visual analogue score and Oswestry disability index after the surgery. All patients were followed up for average 21.5 months （range, 12- 36 months）. Till the last follow-up, all patients with vertebral fractures were healed. No loosening or breaking of internal fixation was observed. Conclusion The posterior paraspinal muscle approach for thoracic and lumbar spine fractures, retaining the posterior ligament complex, is an effective and minimally invasive treatment, with less trauma, less bleeding, the advantages of reliable clinical results.