椎旁肌间隙入路与后正中入路在胸腰椎骨折手术治疗中的应用比较

Comparison the Posterior Paramedian and the Posterior midline Approachs in Therapy the Spinal Fracture

目的比较胸腰椎骨折手术治疗在采用(椎旁肌间隙入路和后正中入路)两种不同入路的临床疗效。方法统计该院2010年6月—2014年6月间收治的胸腰段椎体骨折患者62例,均采用椎弓根钉棒复位内固定术治疗。将所有患者按手术入路不同,分为:Ⅰ组:椎旁肌间隙入路组;Ⅱ组:后正中入路组。对比两组的手术用时、Cobb角纠正率、术中、术后出血量,术后疼痛的VAS评分。结果两组患者手术均顺利完成,术后无并发症。两组患者在术后Cobb角纠正率上差异无统计学意义(P>0.05),Ⅰ组优于Ⅱ组。两组病例在手术时间、术中、术后出血量差异有统计学意义(P<0.05)。术后第1周时两组患者腰背部疼痛差异有统计学意义(P<0.05),Ⅰ组优于Ⅱ组;第2周两组患者腰背部疼痛性差异无统计学意义(P>0.05)。结论在胸腰椎骨折手术治疗中,对比传统的后正中入路,椎旁肌间隙入路在保证压缩椎体高度复位满意的同时,有手术时间短、创伤小、患者疼痛缓解早,术后早期康复等优点。

Objective To compare the surgical treatment of Spinal fractures through two different approaches（Posterior paramedian and the posterior midline）. Methods Study 62 cases of thoracic and lumbar vertebral fracture patients in our hospital from June 2010 to June 2010, All cases adopted pedicle screw fixation treatment. All cases divided into two groups：groups Ⅰ ： the Posterior paramedian approach group. Groups Ⅱ ： the posterior midline approach group. Comparison of two groups in operation time, Correction rate of Cobb angle, blood loss in the operation and postoperative. Pain VAS scores. Results The operations of all cases were completed successfully. None of cases had the postoperative complications. Correction rate of Cobb angle had not statistical difference between the two groups （P 〉 0.05）. The two groups in operation time, blood loss in the operation and postoperative was statistically difference （P 〈 0.05）, group I was better than that of group II. It had statistically difference in the first week after operation between the two groups （P 〈 0.05）, group I was better than that of group II. but had not statistically difference in the second week after operation （P〉0.05）. Conclusion The cases through the posterior paramedian appraoch in the surgical treatment of thoracolumbar fractures was not noly satisfied in restoring the fracture vertebral bodys height but also in spending shorter operation time, getting small trauma and earlier pain relief etc.