传统后正中入路、椎旁肌间隙入路、微创经皮入路治疗胸腰椎骨折的效果比较

Comparison of clinical effects in the treatment of thoracolumbar fractures with traditional posterior approach, paraspinal muscle approach and minimally invasive percutaneous approach

目的比较传统后正中入路、椎旁肌间隙入路、微创经皮入路治疗胸腰椎骨折的临床效果.方法回顾性分析2015年1月至2017年12月山西铝厂职工医院95例胸腰椎骨折患者的临床资料,根据不同手术入路方式将其分为传统后正中入路组(传统组,31例)、后路椎旁肌间隙组(肌间隙组,32例)与微创经皮椎弓根螺钉内固定组(微创组,32例).观察比较三组围术期情况以及术前、术后6个月时后凸Cobb角、椎体前缘高度、腰背部疼痛变化.结果肌间隙组与微创组切口长度、手术时间、术中出血量、住院时间均低于传统组(P均<0.05),其中微创组术中出血量低于肌间隙组(P<0.05).三组术后后凸Cobb角与椎体前缘高度均优于术前(P均<0.05).三组术后VAS评分均低于术前(P均<0.05),其中肌间隙组与微创组VAS评分低于传统组(P均<0.05).结论相较于传统后正中入路,椎旁肌间隙入路与微创经皮入路治疗胸腰椎骨折的效果更为理想,其中微创经皮入路在术中出血量方面优势显著,适合临床推广.

Objective To compare the clinical outcomes of the traditional posterior approach, paraspinal muscle approach, and minimally invasive percutaneous approach for thoracolumbar fractures. Methods The clinical data of 95 patients with thoracolumbar fractures in Shanxi Aluminum Factory Staff Hospital from January 2015 to December 2017 were retrospectively analyzed. According to surgical approaches, they were divided into traditional posterior median group ( traditional group, 31 cases ), paraspinal muscle gap group ( muscle gap group, 32 cases) and minimally invasive percutaneous pedicle screw fixation group ( minimally invasive group, 32 cases). The perioperative conditions of the three groups were observed and compared, and the changes of kyphosis Cobb angle, vertebral height of the vertebral body and low back pain were observed before and 6 months after operation. Results The length of incision, operation time, intraoperative blood loss and hospital stay in the muscle interstitial group and the minimally invasive group were lower than those in the traditional group ( P < 0. 05 ). The intraoperative blood loss in the minimally invasive group was lower than that in the muscle interstitial group ( P<0. 05 ). The kyphosis Cobb angle and the height of the anterior border of the vertebral body were better than those before operation (P<0. 05). The visual analogue scale (VAS) scores of the three groups were lower than those before operation ( P<0. 05 ). The VAS scores of the muscle gap group and the minimally invasive group were lower than those of the traditional group ( P < 0. 05 ). Conclusions Compared with the traditional posterior approach, the paravertebral muscle approach and minimally invasive percutaneous approach for the treatment of thoracolumbar fractures are more effective, and the minimally invasive percutaneous approach has a significant advantage in intraoperative blood loss.It is suitable for clinical promotion.