经椎旁肌间隙入路内固定治疗无神经损伤的胸腰椎骨折的临床观察

Clinical observation of internal fixation via paraspinal approach for thoracolumbar fractures without nerve injury

目的探讨经椎旁肌间隙入路内固定治疗无神经损伤的胸腰椎骨折的临床疗效。方法65例无神经损伤的胸腰椎骨折随机分为两组，后正中人路组30例，肌间隙入路组35例，后正中入路椎弓根内固定治疗，肌间隙入路组采用经椎旁肌间隙入路椎弓根系统内固定治疗，比较两组手术时间，术中出血量以及末次随访时Cobb角纠正率、椎体前缘高度恢复以及JOA评分改善情况。结果两组患者均获随访，时间12—24个月，平均（15±3．7）个月，经椎旁肌间隙组在手术时间、术中出血量、术后1周VAS评分方面优于传统后正中人路组（P〈0．05），末次随访时椎体前缘高度恢复率、Cobb角纠正率、JOA评分比较两组间无明显差异（P〉0．05）。结论经椎旁肌间隙入路治疗无神经损伤症状、无需椎管减压的胸腰椎骨折具有与传统后正中入路相同的临床疗效，且具有减少手术创伤，缩短手术时间，减少术中出血量，降低术后腰背痛等优点，值得临床推广应用。

Objective To discuss the clinical effect of internal fixation via paraspinal approach for thoracolumbar fractures without nerve injury. Methods The clinical data of 65 cases of tuoraeolumbar fractures without nerve injury were divided into two groups：35 cases were included in the paraspinal ap- proach group and 30 cases were in the traditional midline approach group. The operative time, blood loss, Cobb angle, vertebral height and JOA score were recorded. Results All patients were followed up for 12 -24 months ,with an average of （15±3.7 ）month. The paraspinal approach group had a better perform- ance in the operative time ,blood loss and postoperative VAS score at 1st week（ P 〈0.05 ）. There were no significant differences in vertebral height, Cobb angle and JOA score between the two groups（P 〉 0.05 ）. Conclusion Internal fixation via paraspinal approach for thoracolumbar fractures without nerve injury and spinal decompression has the same clinical effect as the traditional midline approach. And it has the advan-tages of less trauma, shorter operative time, little bleeding and fewer lower back pain so that it is worthy of spreading.