椎旁肌间隙入路与传统后入路在胸腰椎骨折后路手术中的比较

Comparison in clinical outcomes between paraspinal approach and conventional approach for thoracolumbar fractures with posterior opperation

目的比较在胸腰椎骨折后路切开复位椎弓根螺钉内固定术中经椎旁肌间隙入路与传统后入路的疗效。方法 2007-12-2010-12收治无神经症状的胸腰段脊柱骨折患者76例,前瞻性地按入院顺序交替归入A组和B组,分别采用传统后入路和椎旁肌间隙入路,收集并比较两组的手术时间、术中出血量及术后引流量,术后3 d、1个月及6个月的腰背部VAS疼痛评分,术前及术后3 d、6个月的患椎后凸Cobb角,术后6个月腰背痛JOA评分、切口并发症等临床指标。结果 B组在手术时间、术中出血量、术后引流量及置钉准确性上均明显优于A组(P<0.05),B组术后1个月及6个月腰背部VAS评分均低于A组(P<0.05),两组在术后3 d的腰背部VAS评分及术后6个月JOA评分差异无统计学意义(P>0.05)。结论椎旁肌间隙入路与传统后入路比较,具有手术操作简单、软组织损伤小、出血少、手术时间短、术后腰背痛缓解快等优势,对于胸腰椎骨折后路切开复位单纯椎弓根螺钉内固定术建议采用椎旁肌间隙入路。

Objective To compare the clinical outcomes of paraspinal approach with those of conventional approach for thoracolumbar fractures with posterior open reduction and pedicle screw fixation. Methods From December 2007 to December 2010,76 patients who suffered from thora-columhar fractures without neurological symptoms were alternately classified into group A and group B prospectively. Groop A were treated through traditional approach while Group B through paraspinal approach. The operative time,blood loss and postoperative drainage were colleced. The VAS scores at 1 day preoperatively and 3 days,1 months and 6 months postoperatively were scored. The anterioposterial Cobb＇s angles of suffered vertebra were measured preoperatively and-at 3 days and 6 months postoperatively. The low back pain JOA scores were scored 6 months post- operatively. The complication of incision were recorded. The outcomes of the above items were compared between Group A and Group B. Results Group B was significantly better than Group A in operative time,blood loss,postoperative drainage and accuraly of pedicle screw （P〈O.05）. The VAS scores of Group B at month 1,6 postoperatively were respectively lower those of Group A （P〈0.05）. The difference was statistically insignificant between Group A and Group B in the VAS scores at day 3 postoperatively and JOA score of low back pain at month 6. postoperatively （P〉0.05）. Conclusions To compare with conventional approach,paraspinal spatium intermusculare approach has the advantages of handy operation,less soft tissue injury and blood loss,short opera- tive time and quick relief of back pain postoperatively,and therefore,the paraspinal spatium inter- musculare approach is strongly proposed to be used for thoracolumbar fractures with posterior open reduction and pedicle screw fixation.