经椎旁肌间隙入路微创小切口在胸腰椎骨折手术的应用

Application of transparavertebral muscular interspace minimal invasive approach in surgery for thoracolumbar fractures

目的探讨椎旁肌间隙入路微创小切口治疗胸腰椎体骨折的临床疗效。方法后路椎弓根钉系统内固定治疗胸腰段椎体骨折患者53例,按手术入路分为椎旁肌间隙入路(A组,28例)和后正中入路(B组,25例)两组。比较两组的手术相关资料。结果 A组手术时间、术中出血量、术后切口引流量、术后3d、1个月和6个月的VAS疼痛评分分别为(78.75±7.53)min、(97.86±37.76)ml、(95.71±34.90)ml、(3.28±0.90)分、(1.71±0.94)分和(1.57±0.92)分,明显低于B组的(85.80±6.87)min、(258.00±65.64)ml、(185.20±62.26)ml、(3.96±0.68)分、(2.28±0.89)分和(2.16±0.99)分(P<0.05);而两组后凸角(Coob角)纠正率和椎体塌陷纠正率相仿(P>0.05)。结论椎旁肌间隙入路微创小切口与后正中入路相比,具有手术野清晰、置钉容易、出血少、手术时间短等优点。

Objective To investigate the outcomes of internal fixation of vertebral pedicle screw via transparavertebral muscular interspace minimal invasive approach for thoracolumbar fractures. Methods Fifty-three patients with tboracolumbar vertebral fractures were operated via transparavertebral muscular interspace minimal invasive approach（group A, 28 cases） or via traditional posterior middle approach（group B, 25 cases）. The surgical outcomes were compared. Results The operation time, operative blood loss, postopeative drainage, VAS scores on the 3rd day, 1st month and 6th month after surgery, corrected rate of Cobb＇s angle and vertebral body height in group A were （78.75±7.53） min, （97. 86±37.76） ml, （95.71±34.90） ml, （3. 28±0.90） points, （1.71±0.94） points and （ 1.57 ± 0. 92） points, which were significantly less than （85.80 ± 6.87） min, （ 258.00 ±65.64） m1,（185.20±62.26） ml, （3.96±0.68） points, （2.28±0.89） points and （2.16±0. 99） points in group B（P〈0. 05）. There were no any significant differences in the correction rate of Cobb＇s angle and vertebral body height between two groups （P〈0. 05 ）. Conclusion Compared to traditional posterior middle approach, transparavertebral muscular interspace minimal invasive approach for internal fixation of vertebral fractures has the advantages of easy manipulation, clear operative field, less hemorrhage, soft tissue damage and operation time.