比较经多裂肌间隙与后正中入路椎弓根内固定治疗胸腰椎骨折的效果

Comparison of clinical effects of treatment of thoracolumbar fractures by paraspinal approach versus posterior central approach

目的 比较经多裂肌间隙入路和后正中入路椎弓根内固定治疗胸腰椎骨折的效果.方法 回顾性分析2016-01—2020-01间郑州人民医院骨科行椎弓根内固定治疗的60例单节段无神经症状胸腰椎骨折患者的临床资料.依据不同手术入路分为2组,观察组经多裂肌间隙置钉(32例),对照组经后正中入路置钉(28例).比较2组手术时间、切口长度、术中出血量、术后引流量,以及术前及术后患者的疼痛视觉模拟评分(VAS)和术矢状面后凸Cobb角.结果 2组手术时间、切口长度差异无统计学意义(P>0.05);观察组的术中出血量和术后引流量均少于对照组,差异有统计学意义(P<0.05).所有患者出院后均获3-6个月随访,观察组术后第1天、1周、3个月时的VAS评分均低于对照组,差异有统计学意义(P<0.05).2组术后6个月的VAS评分,及第1周、3个月、6个月时的矢状面后凸Cobb角差异均无统计学意义(P>0.05).结论 经多裂肌间隙入路和经后正中入路椎弓根钉内固定治疗胸腰椎骨折,均有同样良好的治疗效果.但前者对椎旁软组织剥离少、损伤小,故术中出血量和术后引流量少,更有利于术后腰背疼痛迅速缓解.

Objective To compare the clinical effects of the treatment of thoracolumbar fracture by paraspinal approach versus posterior central approach.Methods The clinical data of 60 patients with single segment asymptomatic thoracolumbar fractures treated with pedicle internal fixation in Zhengzhou people’s Hospital from 2016-01 to 2020-01 were retrospectively analyzed. The observation group was divided into 2 groups according to different surgical approaches. The control group was treated with multiple fissure nail(32 cases). The operative time, incision length, intraoperative blood loss, postoperative drainage and pain visual analogue score(VAS) and cobb angle of sagittal kyphosis were compared between the two groups.Results 2 groups operation time, incision length difference is not statistically significant(P>0.05);The amount of intraoperative bleeding and postoperative drainage in the observation group were less than those of the control group, difference was statistically significant(P<0.05). All patients were followed up 3~6 months after discharge, All the VAS scores in the observation group were lower than those of the control group on day 1, week 1 and month 3, the difference was statistically significant(P<0.05). Group 2 VAS score 6 months after surgery, There was no significant difference in sagittal kyphosis cobb angle at week 1,3 and 6(P>0.05).Conclusion The treatment of thoracolumbar fractures by multiple fissure approach and posterior median approach with pedicle screw fixation has the same good therapeutic effect. However, the former has less detachment and less injury to paravertebral soft tissue, so the amount of intraoperative bleeding and postoperative drainage are less, which is more conducive to the rapid relief of postoperative lumbar back pain.