经椎旁肌间隙入路取出胸腰椎弓根螺钉内固定系统

Clinical application of posterior paraspina approach in removing of thoracic and lumbar pedicle screw internal fixation system

目的探讨经椎旁肌间隙入路取出胸腰椎弓根螺钉内固定系统的临床意义。方法回顾性分析2007年1月-2013年12月我院59例后路胸腰椎弓根螺钉内固定系统取出术患者的临床资料。随机分组,椎旁肌间隙入路取出31例,传统后正中入路取出28例。分别观察两组手术时间、术中出血量及术后引流量等,并行统计分析。结果经椎旁肌间隙入路组平均手术时间(40.2±10.8)min,术中出血量(80.3±29.3)ml,手术后负压球引流总量(64.2±20.1)ml,无脑脊液漏和神经硬脊膜损伤。传统后正中入路组平均手术时间(73.6±14.3)min,术中出血量(182±61.7)ml,术后负压球引流总量(210.1±70.5)ml,脑脊液漏1例,切口愈合不良1例。两组手术时间、术中出血量、术后引流量比较具有显著性差异(P<0.05)。结论经椎旁肌间隙手术入路优于传统后正中手术入路,经椎旁肌间隙入路取出胸腰椎弓根螺钉内固定系统具有时间短、出血少等优点,是一种安全、损伤较小的手术入路。

Objective To evaluate the clinical efficacy and significance of paraspinal muscle approach in removing of thoracic and lumbar pedicle screw internal fixation system. Methods Clinical datas of 59 patients who had pedicle screw removing, were collected between January 2007 and December 2013. Study group included 31 patients who received operations with conventions with paraspinal muscles approach. Control group included 28 patients who received operations with conventional posterior midline approach. Mean-operative time,mean-blood loss,postoperative complication rate were compared between study group and control group. Statistical analysis was used. Results In study group reciving operations with paraspinal muscle approach,mean operative time was 40.2±10.8min,mean blood loss was 80.3±29.3ml,mean postoperative drainage was 64.2±20.1ml;there was no case with cerebrospinal fluid leakage,cauda and dural injury. In control group receiving operations with conventional approach, mean operative time was 73.6±14.3min;mean blood loss was 182±61.7ml;mean postoperative drainage was 210±70.5ml,1incision dural injury was found in 1 cases;incision poor healing was found in 1 cases. There were significant differences in mean operation time,mean blood loss,mean postoperative drainage between two groups（P0.05）. Conclusion Paraspinal muscle approach for removing thoracic and lumbar pedicle screw internal fixation system shows less mean operation time,less bleeding.It provides a safe, effective,minimally invasive surgical option.