微创经椎旁肌间隙入路结合伤椎固定治疗胸腰椎爆裂性骨折的效果及安全性

Efficacy and safety of minimally invasive paravertebral intermuscular approach combined with fixation of fractured vertebra in the treatment of thoracolumbar burst fracture

目的探讨微创经椎旁肌间隙入路结合伤椎固定治疗胸腰椎爆裂性骨折的效果及安全性。方法回顾性分析2010年1月～2015年12月重庆市垫江县人民医院收治的胸腰椎爆裂性骨折77例患者的临床资料，按手术入路方式的不同将其分为两组．微创椎旁肌间隙入路37例（观察组）和传统后正中入路40例（对照组）。比较两组患者的手术时间、术中出血量、术后引流量、视觉模拟评分（VAS）及术后3个月Oswestry功能障碍指数（ODI）；观察患者术前、术后3个月Cobb角、伤椎前缘高度、椎体高度矫正率，及并发症发生情况。结果观察组手术时间、术中出血量、术后引流量明显少于对照组，差异均有统计学意义（P〈0．05）；两组椎体高度矫正率比较，差异无统计学意义（P〉0．05）。术后3个月观察组ODI评分为（8．46＋1．81）分，高于对照组[（20．35＋5．27）分]，差异有统计学意义（P〈0．05）。术后3个月观察组VAS评分、Cobb角及伤椎前缘高度均较术前明显改善，术后3个月观察组VAS评分、Cobb角、伤椎前缘高度低于对照组，差异均有统计学意义（P〈0．05）。两组患者切口均为I期愈合，均未发生切口感染、神经损伤、脑脊液漏等并发症。术后随访3～36个月，患者均未发现内固定松动、折断等。结论与传统后正中入路比较，微创经椎旁肌间隙入路结合伤椎固定术在胸腰椎爆裂性骨折治疗中，手术时间短，术中出血量少，疗效显著，安全性高，值得临床推广。

Objective To explore the efficacy and safety of minimally invasive by paravertebral intermuscular approach combined with fixation of fractured vertebra in the treatment of thoraeolumbar burst fracture. Methods From January 2010 to December 2015, clinical data of 77 patients with thoracolurnbar burst fracture in the Dianjiang People＇s Hospi- tal of Chongqing were retrospectively analyzed, they were divided into two groups according to the different methods of surgical approach： 37 cases of minimally invasive by paravertebral intermuseular approach combined with fixation of fractured vertebra （observation group） and 40 cases of tradition posterior approach （control group）. Operation time, in- traoperative blood loss, postoperative flow, visual analogue scale after operation of patients in the two groups were observed; Cobb leading edge correction rate before and 3 months after operation, （VAS） and Oswestry disability index （ODI） 3 months angle, injured vertebral height, vertebral body height, and its complications of patients were observed. Re- suits Operation time, intraoperative blood loss, volume of postoperative drainage of the observation group were signifi- cantly less than those of the control group, the differences were statistically significant （P 〈 0.05）; vertebral body height correction rate of two groups had no statistically significant difference （P 〉 0.05）. 3 months after operation, ODI score of the observation group was （8.46_＋1.81） scores, which was higher than that of the control group [（20.35~5.27） scores], the difference was statistically significant （P 〈 0.05）. 3 months after operation, VAS score, Cobb angle and anterior height of injured vertebrae in the observation group were obviously improved compared with before operation, and VAS score, Cobb angle, anterior height of injured vertebrae of the observation group 3 months after operation were lower than those of the control group, the differences were statistically significant （P 〈 0.05）. All patients had stage I incision healing, without incision infection, nerve injury, cerebrospinal fluid leakage or other complications, and had no internal fixation loosening and fracture during 3-36 months of follow-up. Conclusion Compared with tradition posterior approach, mini- mally invasive paravertebral intermuscular approach combined with fixation of fractured vertebra in the treatment of thoracolumbar burst fracture is less operative time and intraoperative blood loss, with notable curative effect, high safe- ty, and it is worth of clinical promotion.