经椎旁肌间隙入路治疗胸腰椎骨折的临床研究

Clinical Study on Paraspinal Muscle Approach in Treatment of Thoracolumbar Fracture

目的 探讨经椎旁肌间隙入路复位内固定术治疗胸腰椎骨折的疗效。方法 选取2010年1月至2014年6月期间我院骨科收入的采用后路切开复位内固定术治疗无神经损伤的胸腰段椎体骨折患者43例,随机分为观察组（经椎旁肌间隙入路术）22例和对照组（传统后正中入路术）21例。观察两组患者的手术时间、术中出血量以及术后引流量;观察并记录出院后随访过程中患者疼痛视觉模拟量表（VAS）的评分;计算椎弓根钉置入准确率及后凸Cobb角纠正率（根据患者手术前后正侧位X片评估椎弓根钉置入的位置及后凸畸形程度）。结果 所有患者均获得随访,随访时间为6~18个月。通过观察,发现经椎旁肌间隙入路手术与传统后正中入路手术相比较在手术时间、伤椎Cobb角的矫正率上差异无统计学意义,但在术中出血量、术后引流量、术后疼痛视觉模拟评分（VAS）等方面都具有显著的优势,差异有统计学意义（P〈0.05）。结论 经椎旁肌间隙入路治疗胸腰段椎体骨折具有创伤小、出血少、操作简单、术后患者恢复快等优点。

Objective To investigate the curative effect of reduction and internal fixation with paraspinal muscle approach for the treatment of thoracic and lumbar fractures. Methods From January 2010 to June 2014, a total of 52 cases of non-neurological symptoms patients with thoracic and lumbar spine fractures who were treated with posterior open reduction and internal fixation admitted to our hospital were included and randomly divided into two groups, in which, 22 cases of observation group had paraspinal muscle approach, and 21 cases of control group had posterior midline approach. The operative time, intraoperative blood loss and postoperative drainage volume were observed, the visual analogue scale （VAS） scores after discharge were recorded, and the accuracy of placement of pedicle screw, and the correction rate of Cobb＇s angle were calculated according to the LAT and PA films of X-ray. Results All patients were followed-up for 6 18 months. No significant difference was found in operating time and correction rate of Cobb＇s angle between two groups （P 〉0.05）. Compared with the control group, the observation group was significantly advantageous in intraoperative blood loss, postoperative drainage volume and postoperative VAS score, all the differences between two groups were statistically significant （P 〈0.05）. Conclusions The posterior paraspinal muscle approach for thoracic and lumbar spine fractures has the advantages of less trauma, less bleeding, simple operation and fast postoperative recovery.