不同入路开放性椎弓根螺钉内固定术治疗无神经损伤型胸腰段骨折的疗效分析

Analysis of Efficacy of Open Pedicle Screw Internal Fixation with Different Approaches in the Treatment of Thoracolumbar Spinal Fractures Without Nerve Injury

目的探究无神经损伤型胸腰段脊柱骨折患者开放性椎弓根螺钉内固定术中采用传统后正中入路与椎旁肌间隙入路的临床效果差异。方法纳入无神经损伤型胸腰段脊柱骨折患者68例为研究对象,采用非随机同期对照法分为对照组(36例53椎,行传统后正中入路椎弓根螺钉内固定术)与观察组(32例45椎,行椎旁肌间隙入路椎弓根螺钉内固定术)。比较两组患者临床情况。结果术后3个月、6个月、12个月时,两组患者VAS、ODI评分及矢状面Cobb角均较术前有显著下降,且观察组明显低于同期对照组(P<0.05);两组伤椎椎体前缘高度均较术前有显著提升,且观察组明显高于同期对照组(P<0.05)。观察组患者术中出血量、术后引流量、下床活动时间及住院时间均明显少于对照组(P<0.05)。结论行椎旁肌间隙入路椎弓根螺钉内固定术治疗无神经损伤型胸腰段骨折可简化手术、减少术中创伤,并促进患者术后伤椎形态及腰背功能复旧,相较于传统后正中入路开放性手术更具临床应用价值。

Objective To investigate the clinical effect difference between traditional posterior median approach and paravertebral intermuscular approach in open pedicle screw internal fixation for thoracolumbar spinal fractures without nerve injury.Methods Sixty-eight patients with thoracolumbar spinal fractures without nerve injury were selected for the study.The patients were divided into observation group(36 cases,53 vertebrae,given traditional posterior median approach of pedicle screw internal fixation)and control group(32 cases,45 vertebrae,given paravertebral intermuscular approach of pedicle screw internal fixation)according to the non-randomized concurrent control method.Comparison of clinical conditions of the two groups of patients.Results At 3 months,6 months and 12 months after surgery,the scores of VAS and ODI and sagittal Cobb angle in the two groups were significantly lower than those before surgery,and the indexes in observation group were significantly lower than those in control group(P<0.05).The anterior height of injured vertebral body in the two groups was significantly higher than that before surgery,and the height in observation group was significantly higher than that in control group(P<0.05).The intraoperative blood loss,postoperative drainage volume,ambulation time and hospital stay in observation group were significantly less or shorter than those in control group(P<0.05).Conclusion Pedicle screw internal fixation with paravertebral intermuscular approach for thoracolumbar spinal fractures without nerve injury can simplify the surgery,reduce intraoperative trauma,and promote the restoration of postoperative injured vertebral morphology and lower back function.And it has higher clinical application value compared with open surgery with traditional posterior median approach.