椎旁肌间隙入路在胸腰椎骨折后路手术中的应用

Application of paraspinal spatium intermusculare approach in the posterior approach of thoracolumbar fractures

目的探讨椎旁肌间隙入路在胸腰椎骨折后路切开复位椎弓根螺钉内固定术中的应用效果。方法 130例胸腰段脊柱骨折患者分为椎旁肌间隙入路组(观察组)和传统后入路组(对照组),每组65例;比较2组患者手术情况及术后恢复情况。结果观察组患者手术时间显著短于对照组(P<0.05),术中出血量和术后引流量显著少于对照组(P<0.05)。2组患者术前视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分和Cobb角比较差异均无统计学意义(P>0.05)。2组患者术后3 d及6个月时VAS评分和Cobb角均较术前显著下降,差异有统计学意义(P<0.05),而术后JOA评分较术前显著升高,差异有统计学意义(P<0.05)。2组患者术后3 d VAS评分比较差异无统计学意义(P>0.05);观察组患者术后6个月VAS评分显著低于对照组,差异有统计学意义(P<0.05)。2组患者术后JOA评分、Cobb角和椎体高度矫正率比较差异均无统计学意义(P>0.05)。2组患者均无切口感染、皮下积液、切口裂开、螺钉松动、断钉等并发症发生。结论在胸腰椎骨折后路手术中,椎旁肌间隙入路与传统后入路比较,具有手术操作简单、软组织损伤小、出血少、手术时间短等优点。

Objective To investigate the clinical effect of paraspinal spatium intermusculare approach in posterior open reduction and screw internal fxation for treating thoracolumbar fractures. Methods A total of 130 patients with thoracolumbar fractures were divided into paraspinal spatium intermusculare approach group （observation group） and traditionary posterior ap- proach group（ control group） ,65 cases in each group. The effects of operation and postoperative recovery were compared be- tween the two groups. Results The operation time in observation group was significantly shorter than that in control group （ P 〈 0.05 ）, and the intraoperative bleeding and postoperative drainage volume in observation group were significantly less than those in control group （P 〈 0.05 ）. There was no significant difference in visual analogue scale （VAS） score, Japanese orthopae- dic association（JOA） score and Cobb angle before treatment between the two groups（P 〉 0.05）. The VAS score and Cobb an- gle after 3 days and 6 months of operation were significantly lower than those betore operation in the two groups （P 〈 0.05 ）, but the JOA score after operation was significantly higher than that before operation（ P 〈 0.05 ）. There was no significant difference in VAS score after 3 days of operation between the two groups（ P 〉 0.05 ）. Six months after operation,the VAS score in obser- vation group was significantly lower than that in control group （ P 〈 0.05 ）. There was no significant difference in JOA score, Cobb angle and vertebral height correction rate after operation between the two groups （ P 〉 0.05 ）. The patients in the two groups had no complication such as wound infection, subcutaneous effusion, incision dehiscence, screw loosening and broken nails. Conclusion Paraspinal spatium intermnsculare approach in the posterior approach of thoracolumbar fractures has the advantages of simple operation, small soft tissue injury,less bleeding and short operation time.