椎弓根系统治疗胸腰椎骨折两种手术入路的疗效比较

Comparison of two surgical approaches for thoracolumbar fracture treated by pedicle screw fixation

目的探讨椎旁肌间入路治疗胸腰段椎体骨折的手术方法、疗效及优势。方法选取2017年3月至2018年5月哈尔滨医科大学第二附属医院收治的单节段无神经损伤症状,不需行椎管减压的胸腰段椎体骨折患者49例,随机分为椎旁肌间入路组和传统后正中入路组,行后入路切开复位椎弓根系统内固定术。比较两组手术时间、术中出血量及术后引流量,术前和术后第1天、第3天视觉模拟疼痛(visual analogue score, VAS)评分,术前及术后3 d伤椎后凸角(Cobb角)。结果两组术后在Cobb角恢复上无明显差异(P> 0.05);而椎旁肌间入路组在手术时间、术中出血量、术后引流量及术后VAS评分均低于传统后正中入路组,差异有统计学意义(P <0.05)。全部患者均获得随访,随访时间为5~10个月,平均7.6个月。结论椎旁肌间入路治疗胸腰段骨折疗效确切,且具有创伤小、手术时间短、术后恢复快等优点。

Objective To compare the clinical outcomes of paraspinal approach with those of conventional approach for thoracolumbar fractures with posterior pedicle screw fixation. Methods From March 2017 to May 2018, 49 patients who suffered from thoracolumbar fractures with neurological intact, underwent posterior pedicle screw fixation. The patients were randomly assigned to paraspinal approach group and traditional approach group. Operative time, blood loss volume, postoperative drainage and visual analogue scale(VAS) score were compared. The VAS scores were recorded preoperatively and 1, 3 d postoperatively. The Cobb’s angles of the suffered vertebra were measured preoperatively and at 3 d postoperatively. Results All patients were followed-up five to ten months with an average of 7.6 months. There was no obvious difference in the Cobb’s angle restoration(P > 0.05). But there were obvious advantages of operation time, blood loss volume, amount of drainage and the VAS score in paraspinal approach group, which were statistically significant compare to tratitional approach group(P < 0.05). Conclusions The paraspinal approach has advantages of less soft tissue injury, short operative time and quick relief of back pain postoperatively.