传统入路与后路经椎旁肌间隙入路椎弓根螺钉内固定对腰椎骨折患者的临床疗效和关节功能恢复的影响

The comparision of traditional approach and posterior paraspinal muscle pedicle screw fixation on the clinical efficacy and recovery of joint function in patients with lumbar fracture

目的探讨传统入路与后路经椎旁肌间隙入路椎弓根螺钉内固定对腰椎骨折患者的临床疗效和关节功能恢复的影响。方法回顾性分析2008年10月—2014年3月如皋博爱医院收治的腰椎骨折患者86例,均采用后路经伤椎椎弓根螺钉内固定术,按入路不同分为两组,其中44例采用传统入路,42例采用经椎旁肌间隙入路。术后采用ODI评分评价脊柱功能,采用Harris评分评价髋关节功能,采用美国特种外科医院(HSS)评分评价膝关节功能,进行统计学分析。结果经椎旁肌间隙入路组术中出血量、手术时间、术后VAS评分分别为[(148.7±12.5)mL、(138.5±11.8)min、(4.58±0.77)分],均低于传统入路组[(176.4±15.4)mL、(153.7±12.1)min、(5.48±0.21)分,P<0.05],而术后Harris评分、ODI评分和HSS评分分别为(88.8±7.2)分、(9.2±2.6)%、(87.6±6.8)分,均优于传统入路组[(76.5±6.9)分、(21.7±6.3)%、(80.4±6.2)分],组间差异有统计学意义(P<0.05)。结论后路经椎旁肌间隙入路椎弓根螺钉内固定治疗腰椎骨折可有效降低手术创伤,减少术后疼痛,保护腰背神经,同时有利于患者早期功能锻炼,维护髋、膝关节功能,减少退变。

Objective To investigate the effect of traditional approach and posterior transpedicular approach for pedicle screw fixation on clinical efficacy and joint function recovery in patients with lumbar fractures.Methods Eighty-six patients with lumbar fractures treated in our hospital from Oct. 2008 to Mar. 2014 were treated with posterior percutaneous transpedicular pedicle screw fixation and divided into two groups according to the surgical approaches. Of these,44 patients were treated with the traditional approach（ control group）,42 with paravertebral muscle approach（ observation group）. The postoperative follow-up period was 2 years. ODI score was used to evaluate spinal function. Harris Score was used to evaluate hip joint function. HSS scores of Western Ontario was used to evaluate knee function and statistically analyzed. Results The intraoperative blood loss,operation time,and postoperative VAS score in the observation group were [（ 148. 7 ± 12. 5） mL,（ 138. 5 ± 11. 8） min,（ 4. 58 ±0. 77） points],respectively,which were lower than those in the control group[（ 176. 4 ± 15. 4） mL,（ 153. 7 ± 12. 1）min,（ 5. 48 ± 0. 21） points,P〈0. 05],while Harris scores,ODI scores,and HSS scores were[（ 88. 8 ± 7. 2） points,（ 9. 2 ±2. 6） %,（ 87. 6 ±6. 8） points]were higher than the control group[（ 76. 5 ±6. 9） points,（ 21. 7 ±6. 3） %,（ 80. 4± 6. 2） points],and there was a statistically significant difference between two groups（ P〈0. 05）. Conclusion Posterior paraspinal muscle approach pedicle screw fixation for the treatment of lumbar fractures can effectively reduce surgical trauma and postoperative pain,protect the lumbar dorsal nerve,at the same time,is conducive to early functional exercise in patients,maintain hip and knee function,reduce degeneration.