经椎旁肌间隙入路在胸腰椎手术中的临床应用

Clinical application of paraspinal muscle approach for thoracolumbar spine surgery

目的探讨经椎旁肌间隙入路在胸腰椎手术中的临床应用效果。方法 2009年8月～2012年1月,采用后路切开复位内固定术治疗无神经损伤表现的胸腰段椎体骨折患者及取出椎弓根系统72例。随机采用经椎旁肌间隙入路38例,传统后正中入路34例。比较两组患者手术时间、术中出血量、术后引流量、术后下地时间;疼痛视觉模拟评分(visual analogue scale,VAS)。结果经椎旁肌间隙入路在手术时间、术中出血量、术后引流量、下地时间及VAS评分等方面都具有显著的优势,两者差异有统计学意义(P<0.05)。平均随访时间19.3个月,所有随访患者的胸腰段骨折椎体均获得了良好愈合,无1例发生骨折复位丢失以及内固定物的松动、断裂。结论经椎旁肌间隙入路椎弓根螺钉内固定治疗胸腰椎骨折,具有操作简单、出血少、创伤小、手术时间短、显露清楚、患者恢复快、防止术后腰背痛等优点,符合微创手术的理念一种实用手术。

Objective To investigate the results of the operative treatment of thoracolumbar fractures through the approach between the para-vertebral muscle. Methods From August 2009 to January 2012, a total of 72 patients, who suffered from thoracolumbar vertebral fractures with neurological intact, underwent posterior open reduction and internal fixation, and remo- ving of pedicel screw fixation. Randomly, 38 patients adopted the above approach, 34 patients adopted traditional approach, The operative time, intra operative amount of bleeding, postoperative lead flow, postoperative down time, pain visual analogue scale （ visual analogue scale, VAS） were compared, Results The difference had statistical significance （ P 〈 0.05 ）, All patients were availabled. Neither reduction loss nor loosening or breakage of the fixator had occurred in two groups. Conclusion This technique of operative treatment through the approach between the para-vertebral muscle is much less invasive and applicable for the thoracolumbar fractures, which can reduce the blood loss, accelerate the rehabilitation simultaneously.