椎旁肌间隙入路与后正中入路行一期减压重建治疗胸腰段脊柱骨折脱位

Paraspinal approach and posterior median approach for one-stage decompression reconstruction in the treatment of thoracolumbar spine fracture and dislocation

目的探讨椎旁肌间隙入路与后正中入路行一期减压重建治疗胸腰段脊柱骨折脱位的疗效。方法 2012年1月至2014年1月我院收治胸腰段脊柱骨折脱位患者60例,均行一期减压重建治疗,根据入路方式将患者分为观察组和对照组,观察组30例经椎旁肌间隙入路,对照组30例经后正中入路,行视觉模拟评分(VAS),记录并比较2组患者手术情况、椎体高度恢复、Cobb角改变情况,记录术后并发症发生率。结果观察组手术时间、卧床时间及住院时间分别为(89.16±11.63)min、(39.75±8.69)h、(3.96±1.04)d,均较对照组短,术中出血量为(89.64±13.62)m L较对照组低,差异具有统计学意义(P<0.05);观察组术后1周椎体前缘高度、椎体后缘高度均明显上升,Cobb角明显减少,与术前对比,差异具有统计学意义(P<0.05);观察组治疗后椎旁肌最大冠状径值和最大矢状径分别为(48.96±5.34)mm、(18.16±6.74)mm,显著高于对照组,差异具有统计学意义(P<0.05);观察组腰背疼痛的发生率为3.33%,较对照组23.33%低,差异具有统计学意义(P<0.05)。结论椎旁肌间隙入路行一期减压重建可减轻胸腰段脊柱骨折脱位患者疼痛程度,降低术后腰背疼痛发生率。

Objective To explore the effect of paraspinal approach and posterior median approach for one-stage decompression reconstruction in the treatment of thoracolumbar spine fracture and dislocation. Methods From January 2012 to January 2014,60 patients with thoracolumbar spine fracture and dislocation who were admitted and treated in our hospital were selected as the research objects. All patients received one-stage decompression reconstruction for treatment. According to the methods of approach,the patients were divided into the observation group and the control group. The 30 cases in observation group were treated by paraspinal approach while the other 30 cases in control group were treated by posterior median approach. Visual analogue score（ VAS） was applied. The status of surgery,recovery of centrum height,changes of Cobb angle as well as the occurrence rate of postoperative complications in the two groups were recorded. Results In the observation group,the operative time,time in bed and length of stay were（ 89. 16 ± 11. 63） min,（ 39. 75 ± 8. 69） h and（ 3. 96 ± 1. 04） d respectively,which were shorter than those in the control group. The intraoperative blood loss was（ 89. 64 ± 13. 62） m L which was lower than that in the control group and the difference was significant（ P〈0. 05）. One week after operation,the anterior and posterior height of centrum in the observation group increased significantly while Cobb angle significantly reduced. Compared with those before the treatment,the difference was significant（ P〈0. 05）. The maximum coronary diameter and maximum sagittal diameter of paraspinal muscles in the observation group after the treatment were（ 48. 96 ± 5. 34） mm and（ 18. 16 ± 6. 74） mm respectively,which were significantly higher than those in the control group and the difference was significant（ P〈0. 05）. The incidence of lumbar and back pain in the observation group was3. 33% which was lower than 23. 33% in the control group and the difference was statistically significant（ P〈0. 05）. Conclusion To carry out decompression reconstruction through paraspinal approach can reduce the the pain degree of patients and the incidence of lumbar and back pain after operation.