经椎旁肌间隙入路和传统正中入路行GSS内固定系统治疗胸腰段椎体骨折的效果观察

Effect of paraspinal muscle approach and GSS internal fixation system in the treatment of thoracolumbar vertebral fractures

目的探讨椎旁肌间隙入路并通用型脊柱内固定系统（GSS）治疗胸腰段椎体骨折的临床效果。方法采用随机数字表法将2011年3月~2013年8月收治的90例胸腰段椎体骨折患者分为研究组和对照组各45例,研究组患者采用椎旁肌间隙入路＋GSS内固定系统治疗,对照组采用传统正中入路＋GSS内固定系统治疗,比较两组患者的手术情况、术前术后不同时间的X线片疗效评价指标、手术前后不同时间的腰背部视觉模拟疼痛评分（VAS）及患者Oswestry（ODI）功能障碍指数的变化情况。结果研究组患者的手术时间（86.3±14.7）min、术中出血量（155.7±38.2）m L、术毕切口内残腔体积（10.3±2.6）m L、手术后引流量（106.6±21.7）m L均显著低于对照组患者（P〈0.05）,两组患者的术后住院时间差异不显著（P〉0.05）。术后1周两组患者的伤椎椎体前缘高度比值、Cobb角测定值较术前均显著好转（P〈0.05）。术后末次随访研究组的伤椎前缘高度丢失（1.67±0.21）mm、Cobb角丢失（1.45±0.81）°,均与对照组患者比较差异无统计学意义（P〉0.05）。术后第3个月、末次随访研究组的VAS评分值均显著低于对照组患者（P〈0.05）。术后末次随访研究组ODI评价为优的比例为75.56%,高于对照组的53.33%,术后末次随访研究组的ODI指数显著高于对照组（P〈0.05）。结论椎旁肌间隙入路并GSS内固定系统治疗胸腰段椎体骨折具有手术时间短、操作简单、固定牢固可靠、术后患者恢复更加良好的优点。

Objective To investigate the clinical effect of paraspinal muscle approach and GSS internal fix-ation system in the treatment of thoracolumbar vertebral fractures .Methods Ninety cases of thoracolumbar frac-tures admitted into our hospital from Mar .2011 to Aug.2013 were randomly divided into the study group and the control group ,with 45 cases in each group .Patients in the study group were treated with paraspinal muscle approach＋GSS fixation system and patients in the control group were treated with traditional midline approach ＋GSS fixation system.The operation information , preoperative and postoperative X-rays at different time ,VAS and Oswestry dys-function index （ ODI） changes were compared between the two groups .Results In the study group ,the operative time was （86.3 ±14.7）min,blood loss was（155.7 ±38.2）mL,surgery incision residual cavity volume was （10.3 ±2.6）mL,postoperative drainage was （ 106.6 ±21.7）mL,which were all significantly lower than those of the con-trol group（P〈0.05）.There was no significant difference in the postoperative hospitalization time between the two groups（P〉0.05）.The vertebral height ratio,Cobb angle were significantly improved at 1 week after operation in both groups compared with preoperative values （P〈0.05）.At the last follow-up,in the study group,the vertebral height loss was （1.67 ±0.21） mm,Cobb angle loss was （1.45 ±0.81）＆#176;,which showed no significant difference when compared to the control group （ P〉0.05 ） .The VAS scores at the third month and the last follow-up in the study group were significantly lower than those of the control group （P〈0.05）.At the end of the follow-up,the ex-cellent ratio of ODI in the study group was 75.56%,which was higher than the control group of 53.33%,and the ODI at the last follow-up in study group was also higher than that of the control group （P〈0.05）.Conclusion Paraspinal approach and GSS internal fixation system in the treatment of thoracolumbar vertebral fracture has advan -tages of shorter operation time ,simpler operation ,firmer fixation and better recovery .