经皮多裂肌间隙入路椎弓根螺钉固定治疗无神经损伤胸腰椎骨折的临床疗效分析

Clinical Curative Effect Analysis on Percutaneous Multifidus Muscle Space Approach at the Treatment of Thoracolumbar Fractures without Neurological Deficit

目的探讨经皮多裂肌间隙入路椎弓根螺钉内固定术在治疗无神经损伤的胸腰段骨折的疗效。方法随机选择该院自2013年1月—2014年12月收治的无神经损伤的胸腰段脊柱骨折,Denis分型为Ⅱ型中的ⅡA、ⅡB、ⅡC型,TLICS评分≥4分患者60例。随机分为两组,30例采用经皮多裂肌间隙入路椎弓根螺钉内固定术(实验组)治疗,30例采用传统后正中入路切开复位椎弓根螺钉内固定术(对照组)治疗。观察两组的患者手术时间、术中出血量、术后切口疼痛程度。比较两组患者末次随访时腰背痛视觉模拟评分(VAS评分)、功能障碍指数问卷表(The Oswestry Disability Index,ODI)评分以及矢状面Cobb角和椎体压缩率。结果所有患者均顺利完成手术,随访时间均在12个月以上。两组手术时间、术中出血量、术后切口疼痛程度分别为实验组(52.6±6.1)min、(73.9±16.7)m L、(3.5±1.0)分;对照组分别为(71.7±8.0)min、(241.7±61.9)m L、(5.1±1.7)分,两组比较差异均有统计学意义。两组患者末次随访时的视觉模拟评分(VAS评分)、功能障碍指数(ODI)评分分别为实验组(0.3±0.5)分和(3.1±1.5)分,对照组为(0.6±0.5)分和(4.1±0.7)分,差异有统计学意义(P<0.05),实验组的疼痛指数和功能均优于对照组;末次随访时Cobb角、椎体压缩率分别为实验组(2.4±1.4)%和(4.2±1.9)%,对照组(2.3±1.3)%和(4.1±1.6)%,差异无统计学意义(P>0.05)。结论经皮多裂肌间隙入路和传统后正中入路治疗无神经损伤的胸腰椎骨折具有相似的复位效果。经皮多裂肌入路手术时间短,术中出血少,术后疼痛轻。末次随访时患者腰背部疼痛的缓解程度及生活工作能力的改善程度均优于传统后入路手术。

Objective To explore the clinical result of percutaneous multifidus muscle space approach pedicle screw internal fixation in the treatment of thoracolumbar fracture without neurological deficit. Methods Random selection between January 2013 and December 2014, 60 patients suffering from thoracolumbar vertebral fracture（Denis type ⅡA、 ⅡB、 ⅡC,TLICS≥4） without neurological deficit, were randomly divided into two groups： 30 cases received percutaneous multifidus muscle space approach pedicle screw internal fixation（experimental group） treatment. 30 cases received posterior median approach, open reduction and pedicle screw internal fixation（control group） treatment. Results All patients were successfully completed surgery, follow-up time was more than 12 months. In experimental group, the time of operation was（52.6±6.1）min,the intraoperative blood loss was（73.9 ±16.7） m L and the VAS after operation was（3.5 ±1.0）point;while In control group the time of operation was（71.7±8.0）min,the intraoperative blood loss was（241.7±61.9）m L and the VAS after operation was（5.1±1.7）point respectively, which showed significant difference between the two groups（P〈0.05）. In experiment group, at the time of final follow up the score of back pain VAS and the score of ODI were（0.3±0.5）point and（3.1±1.5）point respectively, while in the control group the date were（0.6±0.5）point and（4.1±0.7）point respectively, which showed significant difference between the two groups（P〈0.05）,the function of experimental group was superior to control group. At the time of final follow up the loss rate of vertebral body and the cobb in experiment group were（2.4±1.4）% and（4.2±1.9）%, in control group were（2.3±1.3）% and（4.1±1.6） %, no significant difference between the two groups（P〈0.05）. Conclusion Percutaneous multifidus muscle space approach at the treatment of thoracolumbar fractures without neurological deficit is effective and reliable surgical method with the advantages of less operative time less blood loss less back pain of VAS and better function.