椎旁肌间隙入路联合棘突旁有限显露治疗伴脊髓损伤胸腰椎骨折的临床观察

Clinical observation of paravertebral muscle approach combined with spinous process limited exposure in treatment of thoracolumbar vertebral fracture with spinal cord injury

目的:探讨胸腰椎骨折伴脊髓损伤患者采用椎旁肌间隙入路联合棘突旁有限显露治疗的效果。方法:选择某院收治的84例胸腰椎骨折伴脊髓损伤患者,按单盲法将其分为观察组和对照组,每组各42例。对照组采用传统后正中入路,观察组采用椎旁肌间隙入路联合棘突旁有限显露。随访6个月,比较2组手术相关指标、影像学参数、神经功能恢复情况。结果:对照组术后引流量、术中出血量均多于观察组,手术时间长于观察组,术后1周VAS评分低于观察组,差异有统计学意义(P <0. 05);术后6个月,2组伤椎Cobb角均较术前低,椎体后缘高度、椎体前缘高度较术前高,Frankel脊髓神经分级均优于术前,差异有统计学意义(P <0. 05); 2组术后6个月伤椎影像学参数比较,差异无统计学意义(P> 0. 05)。结论:胸腰椎骨折伴脊髓损伤患者采用椎旁肌间隙入路联合棘突旁有限显露治疗可获取与传统入路术式相同疗效,且可缓解腰背痛,减轻机体创伤性。

Objective:To investigate the effect of paravertebral muscle approach combined with spinous process limited exposure in treatment of thoracolumbar vertebral fracture.Methods:84 cases of thoracolumbar vertebral fracture with spinal cord injury in a hospital were selected and divided into an observation group and a control group by single blind method,with 42 cases in each group.The control group was treated with traditional posterior median approach,while the observation group was given paravertebral muscle approach and spinous process limited exposure.After 6-month's follow-up,the surgical indexes,imaging parameters,and recovery of nerve function were compared between the two groups.Results:The postoperative drainage volume and intraoperative bleeding volume in the control group were higher than those in the observation group;the operation time of the control group was longer than that of the observation group;the postoperative 1w VAS score of the control group was lower than that of the observation group(P<0.05).6 months after the surgery,the injured vertebral Cobb angle in the two groups were lower than those before the surgery;the heights of posterior and anterior vertebral body in the two groups were higher than those before the surgery;the Frankel spinal cord nerve grading in the two groups were better than those before the surgery(P<0.05).6 months after the surgery,there was no statistical difference in the injured vertebral imaging parameters between the two groups(P>0.05).Conclusion:Paravertebral muscle approach combined with spinous process limited exposure in treatment of thoracolumbar vertebral fracture with spinal cord injury can achieve the same effects as the traditional surgical approach,and it can relieve low back pain and reduce trauma.