胸腰椎椎旁肌间隙入路椎弓根螺钉系统取出的临床研究

Clinical study on posterior paraspinal approach in removing of pedical screw fixation

目的:探讨胸腰椎椎旁肌间隙入路在胸腰椎椎弓根螺钉系统取出术中的应用。方法:选择2007年1月—2013年8月63例胸腰椎骨折后路内固定术后取出椎弓根螺钉系统的患者,随机分为后正中入路组和椎旁肌间隙入路组,其中行后正中入路取出患者30例,行椎旁肌间隙入路取出患者33例。记录并比较两组手术时间、手术出血量、术后24 h疼痛视觉模拟数字法评分(VAS)及住院时间,并行组间比较。结果:所有患者椎弓根螺钉系统均完整拆除,无明显并发症。椎旁肌间隙入路组手术时间(38.1±5.8)min,术中出血量(52.4±7.8)mL,术后24 h及72 h患者腰背部VAS评分为(2.5±0.3)分和(0.6±0.1)分,住院时间(4.0±0.5)d。后正中入路组手术时间(76.0±8.8)min,手术出血量(186.1±25.4)mL,术后24 h及72 h患者腰背部VAS评分为(7.4±0.4)分和(2.4±0.2)分,住院时间(9.1±1.8)d。两组手术时间、手术出血量、腰背部VAS评分及住院时间比较,差异有统计学意义(P<0.05),椎旁肌间隙入路组优于后正中入路组。结论:经椎旁肌间隙入路取出胸腰椎椎弓根螺钉内固定系统有减少手术时间、术后引流量明显减少、创伤小、出血少、疼痛轻、恢复快及住院时间短等优点,是一种安全和损伤较小的术式。

Objective：To investigate the applications of paraspinal muscle approach in removing pedicle screw fixation. Methods： Clinical materials of 63 patients who had pedicle screw removing, were collected from January 2007 to August 2013. Paraspinal muscles approach group included 33 patients who received operations with paraspinal muscles approach. Conventional posterior midline approach group included 30 patients who received operations with conventional posterior midline approach. Mean -operative time, mean -blood loss, postoperative 24 h visual analog pain scale in digital scale（VAS） and hospital stays were compared between two group. Results：All patients were complete removal of pedicle screw system,no significant complications. In paraspinal muscles approach group, mean operative time was （38.1 ± 5.8） rain; mean blood loss was （52.4 ± 7.8 ） mL ;24 h VAS scale and 72 h VAS scale were （2.5±0. 3） score and （0.6 ± 0. 1 ） score, hospital stays was （4.0 ± 0. 5 ） d. In conventional posterior midline approach group, mean operative time was （ 7 6.0± 8.8 ） rain ; mean blood loss was （ 1 8 6. 1± 25.4 ） mL ; 24hVASscaleand72h VAS scale were （ 7.4 ±0.4 ） scoreand （ 2.4 ± 0.2 ） score, hospital stays was （ 9. 1 ±1.8） d. There were significant differences in mean operation time, mean blood loss, postoperative 24 h VAS and hospital stays between two groups（ P 〈 0. 05 ）. Paraspinal muscles approach group was better than conventional posterior midline approach group. Conclusion：Paraspinal muscleapproach for removing pedical screw fixation shows less mean operation time,less bleeding. It provides a safe, effective, minimally invasive surgical option.