脊髓损伤型胸腰椎骨折患者经改良椎旁肌入路手术治疗的临床研究

Clinical study of surgical treatment of thoracolumbar fractures with spinal cord injury via modified paraspinal muscle approach

目的探讨脊髓损伤型胸腰椎骨折患者经改良椎旁肌入路手术治疗的疗效,为临床治疗提供参考依据。方法选择2017年3月至2019年3月我院收治的90例脊髓损伤型胸腰椎骨折患者,通过随机数字表法分为观察组与对照组,每组各45例。观察组使用改良椎旁肌入路开展手术,对照组使用传统后正中入路开展手术,比较两组围术期情况、视觉模拟评分法(VAS)、Cobb角、Frankel分级的变化及并发症情况。结果两组手术时间比较,差异无统计学意义(P>0.05),观察组术中出血量、术后引流量均明显少于对照组(P<0.05);观察组术后1周及6个月时VAS评分均明显低于对照组(P<0.05);两组术后即刻及术后6个月时Cobb角比较,差异均无统计学意义(P>0.05);两组术后6个月Frankel分级比较,差异均无统计学意义(P>0.05);两组术后均无切口感染、手术部位血肿、椎弓根螺钉松动、断裂等并发症。结论经改良椎旁肌入路手术和传统后正中入路治疗脊髓损伤型胸腰椎骨折患者的疗效相似,但经改良椎旁肌入路术中出血量、术后引流量更少,术后疼痛感更轻,值得临床推广应用。

Objective To explore the curative effect of surgical treatment of spinal cord injury(SCI)-induced thoracolumbar fractures by modified paraspinal muscle approach,and to provide a reference for clinical treatment.Methods Ninety patients with thoracolumbar fracture with SCI treated in our hospital from March 2017 to March 2019 were selected and they were randomly divided into observation group(n=45)and control group(n=45).The modified paraspinal muscle approach was used in the observation group and the traditional posterior median approach was used in the control group.The perioperative condition,visual analogue score(VAS),Cobb angle,Frankel classification and complications were compared between the two groups.Results There was no significant difference in surgery time between the two groups(P>0.05).The intraoperative blood loss and postoperative drainage volume in the observation group were significantly less than those in the control group(P<0.05).The VAS score in the observation group was significantly lower than that in the control group at 1 week and 6 months after operation(P<0.05).There was no significant difference in Cobb angle between the two groups immediately after operation and 6 months after operation(P>0.05).There was no significant difference in Frankel grade between the two groups at 6 months after operation(P>0.05).There was no complications such as incision infection,hematoma at operation site,pedicle screw loosening and fracture in both groups.Conclusion The curative effect of modified paraspinal muscle approach is similar to that of traditional posterior median approach in treating patients with SCI-induced thoracolumbar fractures,but the modified paraspinal muscle approach has less blood loss,postoperative drainage and postoperative pain.It is worthy of promotion and application.