后路椎管减压结合椎旁肌间隙入路复位植骨内固定治疗胸腰段骨折伴神经损伤

Posterior approach decompression combined with paraspinal approach reduction,internal fixation,fusion by bone graft in the treatment of thoracolumbar fracture with neurological deficit

[目的]探讨采用后路椎管减压结合椎旁肌间隙入路复位植骨内固定治疗胸腰段骨折伴神经损伤的优越性。[方法]本院2011年10月-2014年2月间,收治胸腰段骨折伴神经损伤患者42例,均采用后路椎板减压复位植骨内固定治疗,其中传统组24例采用传统术式（后正中入路）完成整个手术,改良组18例采用后正中入路减压结合椎旁肌间隙入路复位植骨内固定治疗。对两组手术切口长度、手术时间、术中失血量、手术效果加以对比分析。[结果]相对于传统组,改良组手术切口较小,手术时间较短,术中失血量较少,差异有统计学意义（P〈0.05）,手术效果则无显著差异（P〉0.05）。[结论]采用后路椎管减压结合椎旁肌间隙入路复位植骨内固定治疗胸腰段骨折伴神经损伤是一种合理、微创的手术方式。

[Objective]To investigate the advantages of posterior approach decompression combined with paraspinal approach reduction,internal fixation,fusion by bone graft in the treatment of thoracolumbar fracture with neurological deficit.[Method]From October 2011 to February 2014,42 patients of thoracolumbar fracture with neurological deficit were admitted to our hospital and underwent posterior laminectomy decompression,of which 24 cases were included in conventional group and 18 cases were included in modified group.Surgery for patients in conventional group were accomplished by conventional posterior midline approach.In the modified group,posterior midline approach decompression was combined with paraspinal approach reduction,internal fixation,fusion by bone graft.The data including operative incision lengths,operation time,intraoperative blood loss and operative effect between 2 groups were compared.SPSS13.0 software was used for statistic analysis.[Result]Compared with the conventional group,modified group had shorter incision lengths and operation time,less intraoperative blood loss.There was a statistically significant difference between 2 groups（ P〈0.05）.However,no statistically significant difference in operative effect was found between them（ P〈0.05）.[Conclusion]For patients of thoracolumbar fracture with neurological deficit,this modified surgery technique has the same treatment effect compared to the conventional technique,however,it has advantages of shorter incision lengths and operation time,less intraoperative blood loss.It has been proved to be a reasonable and minimal invasive treatment.