小切口椎旁肌间隙入路、短节段椎弓根螺钉固定治疗胸腰段骨折的临床研究

The clinical effects of short-segment pedicle screw fixation in treating thoracolumbar fractures via less invasive paraspinal intermuscular approach

目的探讨小切口椎旁肌间隙入路、短节段椎弓根螺钉固定治疗胸腰段骨折的临床疗效。方法选择2012年1月—2013年3月期间本院诊治的80例胸腰段骨折患者为研究对象,根据手术方法不同分为A组（38例）及B组（42例）,两组分别行传统入路或小切口椎旁肌间隙入路、短节段椎弓根螺钉固定治疗。比较两组临床疗效及手术效果的差别。结果 B组手术出血量、手术时间及术后VAS评分均显著优于A组（P〈0.05）;随访7～27月,A组末次随访伤椎前缘压缩比、伤椎矢状面Cobb角及椎管占位率分别为91.93±3.65%、4.37±1.62°和6.87±0.63,B组分别为91.78±3.58%、4.40±1.65°和6.90±0.69%,差别无统计学意义（均P＞0.05）;所有患者均获得骨性愈合,未出现螺钉断裂及骨折复位丢失。结论小切口椎旁肌间隙入路、短节段椎弓根螺钉固定治疗胸腰段骨折临床疗效确切,对机体损伤小,有利于术后恢复。

Objective To understand the clinical effects of short-segment pedicle screw fixation in the treatment of thoracolumbar fractures via less invasive paraspinal intermuscular approach. Method 80 patients with thoracolumbar fractures admitted to the hospital from January 2012 to March 2013 were taken as subjects of study. 38 of them constituted the control group,while the other 42 were treated as the experimental group. The control group were treated with traditional approach,while the experimental group with the less invasive paraspinal intermuscular approach combined with shortsegment pedicle screw fixation. Both the clinical effect and operation effects on the two groups were compared. Findings Intraoperative blood loss,operation time and VAS scores after operation observed of the experimental group were superior to those of the control group A（ P 0. 05）. The follow-up period for all the cases was in the range of 7 to 27 months. At Thefinal follow-up,the fractured vertebra height compression ratio,the Cobb＇s angle on sagittal plane and spinal canal occupational ratio in the experimental group were 91. 93 ± 3. 65%,4. 37 ± 1. 62°and 6. 87 ± 0. 63 in the control group,and 91. 78 ± 3. 58%,4. 40 ± 1. 65° and 6. 90 ± 0. 69% in the experimental group（ P 0. 05）; Bone union was achieved in both groups without breakage of screw and second loss of reduction. Conclusion Short-segment pedicle screw fixation in the treatment of thoracolumbar fractures via less invasive paraspinal intermuscular approach have obvious curative effects, less injure and significantly contribute to recovery.