经椎旁肌间隙入路联合伤椎置钉技术椎弓根螺钉内固定治疗胸腰椎骨折的效果分析

Clinical analysis on the effect of paraspinal muscle space approach combined pedicle screw fixation by using the technique of screw insertion in injured vertebrae in the treatment of thoracolumbar vertebra fracture

目的探讨分析经椎旁肌间隙入路联合伤椎置钉技术椎弓根螺钉内固定治疗胸腰椎骨折的效果。方法选择2013年6月—2016年11月期间,在本院接受手术采用后路椎弓根螺钉内固定治疗、无需行椎管减压的单节段胸腰椎骨折患者64例,根据手术入路及固定方式分为两组:治疗组采用经椎旁肌间隙入路联合伤椎置钉技术治疗,对照组采用传统胸腰椎后侧正中切口入路跨伤椎置钉技术治疗。对两组的手术时间、术中出血量、术后引流量、术后下床活动时间、术前术后疼痛视觉模拟评分(VAS)、术前术后伤椎椎体前缘高度比值、后凸Cobb角指数进行比较。结果两组病例均获随访,时间12～29个月,平均(16.4±3.7)个月。两组手术时间长短比较无显著差别,差异无统计学意义(P>0.05)。治疗组在术中出血量、术后引流量、术后下床活动时间、VAS评分、椎体前缘高度比值、后凸Cobb角指数矫正方面均优于对照组,差异有统计学意义(P<0.05)。结论与传统后正中入路跨伤椎固定胸腰椎骨折相比,经椎旁肌间隙入路联合伤椎置钉技术具有创伤小、损伤少、术中术后出血少优点,能减少术后腰背部疼痛及僵硬的发生,矫正伤椎前缘高度及后凸Cobb角疗效满意,是一种安全、有效的微创治疗方法。

Objective To investigate the effect of paraspinal muscle space approach combined with pedicle screw fixation by using the technique of screw insertion injured vertebrae in the treatment of thoracolumbar fracture. Methods From June 2013 to November 2016,64 cases of patients suffered single thoracolumbar vertebra fracture were enrolled in this study,they received posterior pedicle screw internal fixationfor the treatment of thoracolumbar vertebral in our hospital and no need to canal decompression. According to the surgical approach and fixation methods they were divided into two groups： the treatment group was treated by paraspinal muscle space approach combined with pedicle screws fixed on the injured centrum,the control group used the traditional thoracolumbar posterior median incision combined with trans-vertebral pedicle screw technique for the treatment.The operative time,intraoperative blood loss,postoperative drainage volume,postoperative ambulation time,preoperative and postoperative pain visual analogue scale（ VAS）,preoperative vertebral height ratio,and kyphosis Cobb＇s angle index were compared between the two groups.Results All the two groups were followed up for a period of 12-29 months,with an average of（ 16.4±3.7） months. There was no significant difference in the length of operation time between the two groups（ P 0. 05）. The indexes including intraoperative blood loss,postoperative drainage volume,postoperative ambulation time,VAS score,ratio of anterior vertebral height,and kyphosis Cobb＇ s angle in treatment group was better than the control group,the differences were statistically significant（ P0.05）.Conclusions Compared with traditional posterior median approach across vertebral fixation of thoracolumbar fractures, paraspinal muscle approach combined with pedicle screw technique with the advantages including less trauma,less damage,less bleeding and postoperative advantages,can reduce the postoperative back pain and stiffness,the curative effect of correct anterior vertebral height and kyphosis Cobb＇s angle is satisfied,it is a safe and effective minimally invasive treatment method.