肌间隙入路与传统入路椎弓根螺钉内固定治疗胸腰椎骨折

Paraspinal approach versus conventional approach in pedicle screw fixation of thoracolumbar fractures

目的 评价肌间隙入路椎弓根螺钉内固定治疗胸腰椎骨折的临床疗效,并与传统后正中入路手术进行比较. 方法 选择2008年12月-2010年5月收治的42例胸腰椎单椎体骨折患者,行单纯后路椎弓根螺钉内固定复位治疗,其中椎旁肌间隙入路19例（肌间隙入路组）,传统后正中入路23例（传统入路组）.比较两组切口长度、手术时间、术中出血量、术后引流量、术后住院时间、术前与术后视觉模拟评分（visual analogue scale,VAS）围术期指标及伤椎骨折复位情况,并行术后Oswestry功能障碍指数（Oswestry disability index,ODI）功能评估. 结果 两组切口长度、手术时间、术后住院时间、伤椎高度恢复差异无统计学意义（P＞0.05）.肌间隙入路组术中出血量为（148.5±26.5） ml,术后引流量为（72.9±17.3） ml,术后VAS评分为（1.1±0.3）分,ODI功能评分为（13.4±2.7）分,与传统入路组比较,差异有统计学意义（P＜0.05）. 结论 与传统后正中入路相比,采用椎旁肌间隙入路具有创伤小、出血少、疼痛轻、恢复快等优点,可作为无需椎管内减压的椎体骨折的首选手术入路.

Objective To estimate the effect of pedicle screw fixation of thoracolumbar fractures via paraspinal approach and compare it with the conventional posterior midline approach.Methods Forty-two cases of thoracolumbar monosegmental fractures subjected to single posterior pedicle screw fixation and reduction from December 2008 to May 2010 were included in the study.Among the patients,19 cases were operated through paraspinal muscular-sparing approach （paraspinal approach group） and 23 cases through posterior midline surgical approach （conventional approach group）.Surgical incision length,operation time,intraoperative blood loss,postoperative drainage volume,postoperative hospital stay,pre-and post-operative VAS and other perioperative indices as well as fracture reduction outcome were compared between the two groups.Oswestry disability index （ODI） was assessed after operation.Results There were no statistical differences between the two groups in aspects of surgical incision length,operation time,postoperative hospital stay,height restoration of fractured vertebra （P 〉 0.05）,but intraoperative blood loss （148.5 ± 26.5） ml,postoperative draining loss （72.9 ± 17.3） ml,postoperative VAS （1.1 ± 0.3） points and ODI （13.4 ± 2.7） points in paraspinal approach group showed statistical differences from those in conventional approach group （P 〈 0.05）.Conclusion Paraspinal muscle-sparing approach is characterized by minor trauma,less bleeding,slight pain and quick recovery as compared with conventional posterior midline approach and hence may be the preferred choice for the treatment of thoracolumbar fracture without spinal canal decompression.