经多裂肌间隙后路手术治疗胸腰椎骨折的前瞻性研究

Prospective study of posterior approach through multifidus for thoracolumbar fractures

目的探讨经多裂肌间隙入路行胸腰椎骨折后路手术的临床疗效。方法将2010年3月至2013年3月九江市中医院和深圳市南山区人民医院收治的60例无需减压的胸腰椎骨折患者随机分为两组,其中经多裂肌间隙入路30例(观察组)、后正中传统入路30例(对照组),比较两组手术时间,术中出血量,术后引流量,住院时间,术后Cobb角矫正率、椎体高度矫正率、疼痛视觉模拟量表(VAS)评分等指标。结果两组术后Cobb角矫正率、椎体高度矫正率比较,差异无统计学意义(P>0.05);观察组手术时间、术中出血量、术后引流量、住院时间、术后VAS评分明显优于对照组(P<0.05)。结论与后正中传统入路相比,经多裂肌间隙入路治疗胸腰椎骨折具有手术和住院时间短、手术创伤轻微、术后腰痛症状改善明显等优点。

Objective To investigate the clinical outcomes of thoracolumbar fractures treated by posterior approach through multifidus. Methods Treated in Jiujiang Hospital of Traditional Chinese Medicine and Shenzhen Nanshan District People＇s Hospital from March 2010 to March 2013, 60 patients suffered from thoracolumbar fractures and not required surgical decompression were divided into 2 groups randomly, 30 patients in control group underwent traditional posterior surgical approach and other 30 patients in study group received posterior approach through multifidus. Clinical indicators such as operation time, intraoperative estimate blood loss, postoperative drainage, length of hospital stay, postoperative Cobb angle correction rate, vertebral body height correction rate and pain visual analogue scale （VAS） score were compared between two groups.＆nbsp;Results The differences of postoperative Cobb angle correction rate, vertebral body height correction rate between two groups had no statistical significance （P 〉0.05）. In terms of operation time, intraoperative estimate blood loss, postoperative drainage, length of hospital stay, postoperative VAS score in treatment group they were better than those in control group （P 〈0.05）. Conclusion Compared with traditional posterior approach, multifidus approach for thoracolumbar fractures provides better clinical effects because it showed shorten operation time and hospital stay length, reduce surgical injury and accelerate recovery of low back pain.