不同手术入路治疗胸腰椎爆裂骨折的临床疗效

Clinical effect observation of different approaches in the treatment of thoracolumbar burst fracture

目的:探讨经椎旁肌间隙入路与传统后正中入路治疗胸腰椎爆裂骨折临床疗效。方法:回顾分析60例获得6个月以上随访的胸腰椎爆裂骨折病人临床资料,其中采用经椎旁肌间隙入路手术治疗30例(观察组),经传统后正中入路手术治疗30例(对照组),比较2组病人手术持续时间、术中出血量、术后引流量、术后疼痛视觉模拟评分(VAS评分)、伤椎前缘高度及伤椎体Cobb角,对2种手术入路进行疗效评价。结果:观察组患者手术持续时间、术中出血量及术后引流量均明显少于对照组(P<0.01);观察组术后1周及术后6个月VAS评分均明显低于对照(P<0.01);2组病人术后1周及术后6个月Cobb角改善及椎体前缘高度恢复情况差异均无统计学意义(P>0.05)。结论:经椎旁肌间隙入路与经传统后正中入路治疗胸腰椎爆裂骨折均可达到理想疗效,但椎旁肌间隙入路具有出血少、创伤小及患者疼痛小等优点,值得临床推广。

Objective:To investigate the clinical effects between posterior paraspinal muscle approach and conventional posterior middle approach in the treatment of thoracolumbar burst fractures.Methods:The clinical data of60thoracolumbar burst fractures patients followed by more than6months were retrospectively analyzed.Thirty cases were treated with posterior paraspinal muscle approach(observation group),and30cases were treated with conventional posterior middle approach(control group).The operative time,peroperative bleeding,and postoperative drainage,VAS score,anterior height of vertebral body and Cobb angle between two groups were compared,which was used to evaluate the treatment effects of two approaches.Results:The operative time,peroperative bleeding and postoperative drainage in observation group were significantly less than those in control group(P<0.01).The VAS score in observation group was significantly lower than that in control group1week and6months after operation(P<0.01).The differences of the anterior height of vertebral body and Cobb angle1week and6months after operation between two groups were not statistically significant(P>0.05).Conclusions:The treatment effect of thoracolumbar burst fracture with posterior paraspinal muscle approach and conventional posterior middle approach are ideal.The treatment of posterior paraspinal muscle approach is less bleeding,injury and pain,which is worthy of promotion in clinic.