3种不同手术入路治疗胸腰椎骨折的疗效比较

Comparison effect of three different surgical approaches in the treatment of thoracolumbar fractures

目的比较传统后正中入路、椎旁肌间隙入路、微创经皮入路3种不同手术入路治疗胸腰椎骨折的临床效果。方法将60例胸腰椎骨折患者按不同手术入路方式分为传统组(采用传统后正中入路)、肌间隙组(采用椎旁肌间隙入路)及经皮组(采用微创经皮入路),每组各20例。比较3组患者的手术情况、血清肌酸激酶、VAS评分、ODI评分及术后影像学指标。结果患者均获得随访,时间13~19个月。3组患者切口均一期愈合,未出现严重并发症。3组患者的切口长度、手术时间、术中出血量、住院时间、术后各时间段的伤椎前缘高度比及后凸Cobb角两两比较差异均无统计学意义(P>0.05)。血清肌酸激酶水平:术后第1、3天传统组明显高于肌间隙组与经皮组,差异有统计学意义(P<0.05),术后第7天3组间比较差异无统计学意义(P>0.05)。VAS评分及ODI评分:术后3个月肌间隙组及经皮组优于传统组(P<0.05),术后1周及术后12个月3组两项评分两两比较差异均无统计学意义(P>0.05)。结论手术治疗无神经症状的胸腰椎骨折,椎旁肌间隙入路与微创经皮入路均符合微创理念,而椎旁肌间隙入路稍显优势。

Objective To compare of the clinical efficacy of traditional posterior median approach,paraspinal approach and minimally invasive percutaneous approach in the treatment of thoracolumbar fractures.Methods The 60 cases patients of thoracolumbar fractures were treated by surgery via different surgical approaches,including traditional group(the middle approach),paraspinal group(paraspinal approach)and percutaneous group(minimally invasive percutaneous approach),20 cases in each group.The 3 groups were compared by the operation condition,serum creatine kinase,VAS,ODI score and postoperative imaging parameters.Results All patients were followed up for 13~19 months,the incisions were all healed by the first intention and recovered without any serious complications.The incision length,surgical time,intraoperative blood loss,hospitalization time,imaging follow-up of injuried vertebra anterior height and Cobb′s angles had no statistically significant differences(P>0.05).Serum creatine kinase levels in traditional group were significantly higher than the other two groups on day 1 and 3 after operation(P<0.05).On the day 7 after operation,the serum creatine kinase level had no statistically significant difference(P>0.05).The VAS and ODI score in paraspinal group and percutaneous group were significantly lower than the traditional group in 3 months after operation(P<0.05),which had no statistically significant differences in 1 week and 12 months after operation in 3 groups(P>0.05).Conclusions The surgical treatment of thoracolumbar fractures without neurological symptoms,paraspinal approach and minimally invasive percutaneous approach are both in the concept of minimally invasive,however,the former shows a slight advantage.