经椎旁肌间隙入路治疗胸腰椎骨折疗效及对预后影响

Effect and prognosis of patients with thoracic and lumbar fractures by paraspinal muscle-space approach

目的探讨经椎旁肌间隙入路治疗胸腰椎骨折的疗效及对预后的影响。方法回顾性分析武汉市中医医院自2017年1月至2018年1月收治的85例胸腰椎骨折患者的临床资料,分成A组(n=40)与B组(n=45)。A组采取正中入路,B组采取经椎旁肌间隙入路。比较两组的手术切口长度、手术时间、术中出血量、术后引流量、术后卧床时间、住院时间等围术期指标,比较手术前、后视觉模拟评分(VAS)、日本骨科协会评估治疗评分(JOA)、日常生活能力(ADL)评分、Cobb角及椎体前缘相对高度。结果B组患者围术期指标均优于A组;B组患者术后1、3个月的VAS评分明显低于A组,JOA评分明显高于A组,ADL评分明显高于A组,差异均有统计学意义(P<0.05)。术后,两组患者Cobb角、椎体前缘相对高度均较术前改善,差异有统计学意义(P<0.05)。结论椎旁间隙入路手术治疗胸腰椎骨折,具有手术创伤小、操作简单、出血少、恢复快等特点,术后腰背疼痛症状明显缓解,预后较好。

Objective To investigate the effect and prognosis of paraspinal muscle-space approach on patients with thoracic and lumbar fractures.Methods A retrospective study was performed on 85 cases of patients with thoracic and lumbar fractures who were admitted from January 2017 to January 2018.Patients were divided into the Group A(median approach,n=40)and Group B(paraspinal muscle space approach,n=45).Two groups of incision length,operative time,intraoperative blood loss,postoperative such as flow rate,length of hospital stay,postoperative bed time,perioperative indicators,compare the visual analogue scale(VAS)before and after surgery,the Japanese orthopaedic association evaluation score(JOA)treatment and activity of daily life(ADL)score,Cobb Angle and fanterior edge relative height were compared.Results The perioperative indexes of the patients in Group B were all better than those in Group A,and the VAS scores of the patients in Group B at 1 and 3 months after the operation were significantly lower than those in Group A,JOA scores were significantly higher than those in Group A,and ADL scores were significantly higher than those in Group A,with statistically significant differences(P<0.05).The Cobb Angle and the relative height of the anterior edge of the vertebral body in the two groups were improved after operation(P<0.05).Conclusion Paraspinal space approach for the treatment of thoracolumbar fractures has the advantages of less trauma,simple operation,less bleeding and fast prognosis.It can relieve the symptoms of lumbar back pain and improve the daily life of patients after operation and can be used as the main treatment of thoracolumbar fracture.