棘突旁小切口经多裂肌间隙入路多节段固定在腰椎结核后路手术中的应用

Application of multifidus muscle gap approach with small incision on the sides of spinous process in posterior surgery in lumbar tuberculosis

目的比较棘突旁小切口经多裂肌间隙入路与后正中入路在腰椎结核后路手术中的差异。方法选取2009年1月至2013年3月收治的腰椎结核患者90例,进行随机分组,治疗组45例:小切口多裂肌间隙入路;对照组45例:后正中入路。对两组的手术时间、手术的出血量、手术前后视觉模拟评分法(VAS)评分、切口引流情况进行对比。内固定取出术后6个月随访腰椎MR检查。组间数据统计分析采用t检验和χ2检验。结果治疗组与对照组在手术时间[(93±12.40)min vs.(150±16.90)min,t=18.381,P<0.01]、出血量[(121±39.62)ml vs.(340±47.83)ml,t=23.897,P<0.01]、切口引流量[(56±14.2)ml vs.(131±11.5)ml,t=27.533,P<0.01]及引流管拔除时间[(39±8.5)h vs.(51±11.1)h,t=5.758,P<0.01]差异均有统计学意义。术后VAS评分治疗组与对照组在1周(3.28±1.02 vs.4.49±1.13,t=5.972,P<0.01)、1个月(2.16±0.81 vs.3.54±0.88,t=7.740,P<0.01)、3个月(1.03±0.75 vs.2.42±0.64,t=9.457,P<0.01)差异均存在统计学意义。内固定取出术后6个月MR检查随访结果显示,治疗组与对照组手术区域多裂肌间隙出现纤维化及高密度区的例数分别为7例和28例,差异有统计学意义(χ2=20.618,P<0.01)。结论在腰椎结核手术中棘突旁小切口多裂肌间隙入路足够进行椎弓根螺钉置入,入路创伤小,愈合满意,患者疼痛较轻,优于后正中入路,值得临床推广。

Objective To compare the differences of minimally invasive small incision next to positive multifidus muscle gap approach and posterior midline approach in lumbar tuberculosis posterior surgery.Methods 90 cases of lumbar tuberculosis in our surgical department from January 2009 to March 2013 were randomly divided into two groups, multifidus muscle gap approach with small incision on the sides of spinous process group （observation group） and posterior midline approach group （control group）, the index （operation time, blood loss, visual analogue scale, wound hematoma） were compared before and after surgery, follow-up of MR imaging in the lumbar spine were done in 6 months after remove internal fixation, compared using thettest or chi-square test between groups.Results Treatment and control groups were statistically significant in operative time, （93±12.40）minvs. （150±16.90）min （t=18.381,P〈0.01）, bleeding, （121±39.62）ml vs. （340±47.83）ml （t=23.897,P〈0.01）, cut the lead flow, （56±14.2）ml vs. （131±11.5）ml （t=27.533,P〈0.01） and the drainage tube removal time, （39±8.5）h vs. （51±11.1）h （t=5.758,P〈0.01）. Postoperative VAS scores of treatment and control groups in one week were 3.28±1.02 vs.4.49±1.13 （t=5.972,P〈0.01）; one month： 2.16±0.81 vs.3.54±0.88 （t=7.740,P〈0.01）; 3 months： 1.03±0.75 vs.2.42±0.64 （t=9.457,P〈0.01）, there is a statistically significant difference. The number of cases of fibrosis and high-density zones in the surgical field gap multifidus muscle appearing in the follow-up MR imaging （6 months after remove internal fixation） in the treatment group and the control group were 7 cases and 28 cases, the difference was statistically significant （χ2=20.618,P〈0.01）. Conclusion Multifidus muscle gap approach with small incision on the sides of spinous process in posterior surgery in lumbar tuberculosis is sufficient for pedicle screw implantation, and the healing of small incision is satisfied, patients feel less pain, it is better than posterior midline approach and deserve the clinical expansion.