胸腰椎骨折后路内固定不同显露方式治疗效果比较

A comparative study on effect of different revealing approaches for posterior fixation in patients with thoracolumbar fracture

目的比较自椎旁肌间隙入路与常规入路两种显露方式治疗胸腰椎骨折的效果。方法分析收治的98例胸腰椎骨折患者临床资料,其中椎旁肌间隙入路62例,常规入路36例,测量并比较两组患者手术过程中所需时间、出血量,手术后视觉模拟(VAS)疼痛评分、引流量、并发症发生情况和腰椎功能日本矫形科学学会(JOA)评分和Cobb角矫正率。结果两组患者手术所需时间、出血量、VAS疼痛评分、引流量、JOA评分和Cobb角矫正率差异有统计学意义(P<0.05)椎旁肌间隙入路组手术所需时间、出血量、VAS疼痛评分及引流量低于常规入路组,而JOA评分、Cobb角矫正率高于常规入路组(P<0.05)。肌间隙入路组术后伤口感染和开裂的发生率也低于常规入路组(P<0.05)。结论自椎旁肌间隙入路在胸腰椎骨折患者中取得了较好的治疗效果,相对于常规入路方式,具有手术损伤小、术后恢复好的优点。

Objective To compare the effect of surgical treatment in patients with thoracolumbar fracture by paraspinal muscle space approach and ordinary approach. Methods Clinical data of 98 patients with thoracolumbar fracture were analyzed. Paraspinal muscle space approach was applied in 62 patients, and 36 patients were applied with ordinary approach. The operating time, amount of blood loss during operation, VAS scores, drainage, incidence of complications, JOA scores of lumbar function, and Cobb angle correction rate after operation were compared between these two groups. Results There was signifiant difference in operating time, amount of blood loss during operation, VAS scores, drainage, JOA scores of lumbar function, and Cobb angle correction rate after surgery between these two groups （ P 〈 0.05 ）. The operating time, blood loss in operation, VAS scores and drainage were lower in paraspinal muscle space approach group, the JOA scores of lumbar function and Cobb angle correction rate were higher in paraspinal muscle space approach group in comparison with those of ordinary group. The incidence of wound infection and breakage in paraspinal muscle space approach group was also lower than that of ordinary approach group. Conclusion Paraspinal muscle space approach is effective in treatment of patients with thoracolumbar fracture. In comparison with ordinary approach, it has the advantages of less trauma and better recovery.