椎旁肌间隙入路和传统入路在治疗胸腰段骨折对椎旁肌损伤的比较研究

Comparison of paraspinal muscle injury due to paraspinal approach or conventional open approach treatment of thoracolumbar fractures

[目的]比较椎旁肌间隙入路与传统入路在治疗胸腰段骨折中对多裂肌的影响。[方法]自2010年6月～2012年6月,共45例胸腰段骨折满足研究条件的随机分为椎旁肌间隙入路21例和传统正中手术入路24例,比较两组术前及术后1、3、5 d肌酸激酶水平,术后6个月随访时行椎旁肌肌内静息肌电图评估及磁共振检查评估椎旁肌肉萎缩程度,16例患者取内固定行多裂肌组织学检查。[结果]肌酸激酶传统入路组术后高于椎旁肌间隙入路组,术后第1、3 d差异具有统计学意义,第5 d差异不具有统计学意义。6个月随访行多裂肌肌电图检查及磁共振检查,发现椎旁肌间隙入路组出现失神经纤颤电位少且MRI评分高,差异具有统计学意义(P<0.05),而术后组织学检查发现类似的结果。[结论]传统手术入路和和椎旁肌间隙入路对多裂肌均有损伤,但椎旁肌间隙入路对椎旁肌损伤小于传统手术入路。

[ Objective ] To determine the differences in paraspinal muscle injury due to paraspinal approach and traditional open approach treatment method for thoracolumhar fractures. [ Method ] From June 2010 to June 2012,45 patients were enrolled in this study. The patients were randomly assigned to 2 groups ：21 patients underwent the Wihse approach and the remaining 24 underwent the traditional approach. The following data were compared between the 2 groups：surgical time,amount of blood loss, and changes in postoperative creatinine kinase （CK）serum levels. More than 6 months after the operation,all the patients were followed up, and each group was evaluated using electromyography （EMG） and magnetic resonance imaging （MRI）. On the ba- sis of these results, the fixtures were removed from 16 patients and histological assessment was performed. [ Result] The CK lev- els were significantly lower in the Wihse approach group than in the traditional approach group 3 days after surgery; however, at day 5, no differences were observed in the CK levels. At the 6 - months follow up, each group was evaluated using EMG and MRI. The Wiltse approach group had lower fibrillation potential and higher MRI scores than the traditional approach group. The difference between the 2 groups was statistically significant（ P 〈 0.05 ）. Similar results were found on comparison of the postop- erative histological scores between the 2 groups. [ Conclusion] Both the Wiltse approach and traditional approach caused damage to the paraspinal muscle, however, the muscle damage was less while using the Wihse approach.