经椎旁肌间隙入路与后正中入路治疗胸腰椎骨折的比较

Comparison of the paraspinal approach and the posterior midline approach for treating the thoracolumbar fracture

目的:比较经椎旁肌间隙入路与传统后正中入路治疗胸腰椎骨折的临床效果。方法:选取我院收治的无神经损伤的单节段胸腰椎骨折患者86例,按照手术方式的不同分为肌间隙入路组44例和传统后正中入路组42例,比较两组患者手术时间、术中出血量及随访获得的VAS评分等资料。结果:所有病人获得至少6个月的随访。两组手术时间、术中X线暴露时间、Cobb角纠正率、伤椎高度改善率以及椎弓根钉置入准确率差异无统计学意义(P>0.05),肌间隙入路组术中出血量、术后引流量、术后住院时间明显少于后正中入路组(P<0.05),术后VAS评分、血肌酸激酶同工酶(CK-MB)值明显低于后正中入路组(P<0.05)。结论:经椎旁肌间隙入路较之传统后正中入路治疗无神经损伤的胸腰椎骨折,临床疗效无明显差异,并具有创伤小、术后恢复快以及疼痛缓解明显等优点,值得推广。

Objective： To compare the clinical efficacy of treating the thoracolumbar fracture through paraspinal approach and conventional posterior midline approach. Methods： 86 patients with single-segment thoracolumbar fracture without nerve injury were divided into two groups according to different surgical approaches,which were paraspinal approach group（ 44 cases） and posterior midline approach group（ 42 cases） respectively. The clinical data collected,such as operation time and blood loss,and the following-up data,such as the VAS scores were compared the two groups. Results： All the patients were followed up for six months at least. There were no significant differences of the operation time,X-ray exposure time,the correcting rate of Cobb’s angle,the improvement rate of the height of injured segment,and accuracy of pedicle screw placement between paraspinal approach group and posterior midline approach group（ P 〉 0. 05）. The blood loss,postoperative volume of drainage and postoperative hospitalization of the paraspinal approach group were significantly less than those of the posterior midline group（ P 〈 0. 05）. The postoperative VAS scores and CK-MB of the paraspinal approach group were lower than those of the posterior midline group（ P 〈 0. 05）. Conclusion： The paraspinal approach was wroth promoting with the advantages of less trauma,quicker postoperative recovery and more significant pain relief,while it has the same clinical efficacy compared with the conventional posterior midline approach for treating the single-segment thoracolumbar fracture without nerve injury.