改良肌间隙入路小切口微创钉棒植入治疗胸腰椎骨折

Improve intermuscular septum approach small incision minimally-invasive screws/rods implantation for thoracolumbar fracture treatment

目的探索利用肌间隙的改良小切口入路微创钉棒植入治疗胸腰椎骨折的方法。方法选取2015年1月至2019年1月本院收治的胸腰椎骨折患者25例,采取棘突两边旁正中分别作一长约4.0 cm左右的切口,体表投影相当于多裂肌与最长肌之间的间隙,在多裂肌外侧间隙钝性分离至小关节突表面,植入椎弓根钉。结果其中胸椎骨折4例,腰椎骨折21例;平均手术时间(45.2±8.3)min,平均失血量(46.3±8.2)mL。全部病例均获随访,平均时间7个月。疗效判定参考VAS评分标准:优21例,良3例,可1例,优良率96.0%。结论采用肌间隙的改良小切口入路微创钉棒植入治疗胸腰椎骨折的方法,简单实用、失血少、损伤小,可行性高,术后疼痛轻,有较高的临床应用价值。

Objective To explore a method of minimally invasive screw-rod system implantation for the treatment of thoracolumbar fractures using the modified mini-incision approach of muscle space.Methods 25 cases of thoracolumbar fractures treated in our hospital from January 2015 to January 2019,a 4 cm incision was made in the paracentric center on both sides of the spinous process.The surface projection was equivalent to the gap between the multifidus muscle and the longest muscle.Results There were 25 cases,of which 4 were thoracic vertebrae and 21 were lumbar vertebrae.The average operation time is 50 minutes,and the average loss of blood is about 50 milliliters.All cases were followed up,with an average time: 7 months.Reference to VAS scoring criteria for efficacy determination: excellent 21 cases,good 3 cases,fine 1 case,excellent and good rate of 96.0%.Conclusion the method of minimally invasive screw-rod system implantation in the treatment of thoracolumbar fracture by the modified mini-incision approach of intermuscular space is recommended.Simple and practical,less blood loss,less damage,high feasibility,high clinical application value.