椎旁肌间隙入路与传统后入路椎弓根螺钉内固定治疗胸腰椎骨折的疗效对比

Comparison of Paravertebral Space Approach and Traditional Posterior Approach Pedicle Screw Internal Fixation for Thoracolumbar Fracture

目的探析经椎旁肌间隙入路治疗胸腰椎骨折切开复位内固定术中的疗效。方法回顾性分析2018年5月—2021年6月海东市平安区中医医院收治的单阶段无神经损伤胸腰椎压缩或爆裂骨折患者63例临床资料,按治疗方法分为经椎旁肌间隙入路A组(n=33)和传统后正中入路B组(n=30)。比较两组手术时间、术中出血量、术后引流量,术后12 h、3 d血清肌酸激酶,术后1周、1个月、3个月VAS评分,以及术后6个月JOA评分。结果A组手术时间(94.6±6.95)min短于B组(144.8±5.49)min;术后引流量(81.2±14.58)mL少于B组(161.9±29.70)mL,术中出血量(169.4±20.45)mL少于B组(246.3±26.75)mL,差异有统计学意义(t=31.595、18.884、12.886,P<0.05)。术后12 h、术后3 d,A组血清肌酸激酶低于B组,差异有统计学意义(P<0.05)。术后1周、1个月、3个月,A组VAS评分均低于B组,差异有统计学意义(P<0.05)。术后6个月,A组JOA评分高于B组,差异有统计学意义(P<0.05)。结论在腰椎后路手术当中,经椎旁肌间隙入路操作相对简便,可明显缩短手术时间,减少出血量,避免对椎旁周围肌肉及关节囊的损伤,有效缓解术后腰背部疼痛。

Objective To explore the efficacy of open reduction and internal fixation for thoracolumbar fractures through paravertebral space approach.Methods Retrospective analysis of the clinical data of 63 patients with single stage non nerve injury thoracolumbar compression or burst fractures admitted to Ping´an District Traditional Chinese Medicine Hospital in Haidong City from May 2018 to June 2021.They were divided into two groups according to treatment methods:group A(n=33)through the paravertebral muscle space approach and group B(n=30)through the traditional posterior median approach.Compare the surgical time,intraoperative bleeding volume,postoperative drainage volume,serum creatine kinase at 12 hours and 3 days after surgery,VAS scores at 1 week,1 month,and 3 months after surgery,and JOA scores at 6 months after surgery between the two groups.Results The surgical time in group A(94.6±6.95)minutes was shorter than that in group B(144.8±5.49)minutes,respectively;the postoperative drainage volume in group A(81.2±14.58)mL was less than group B(161.9±29.70)mL,and the intraoperative bleeding volume in group A(169.4±20.45)mL was less than group B(246.3±26.75)mL,the difference was statistically significant(t=31.595,12.886,18.884,P<0.05).At 12 hours and 3 days after surgery,the serum creatine kinase levels in group A were significantly lower than those in group B,the difference was statistically significant(P<0.05).At 1 week,1 month,and 3 months after surgery,the VAS scores of group A were lower than those of group B,the difference was statistically significant(P<0.05).At 6 months after surgery,the JOA score in group A was higher than that in group B,the difference was statistically significant(P<0.05).Conclusion In posterior lumbar surgery,the paravertebral space approach is relatively simple,significantly shorting the operation time,reducing the amount of blood loss,avoiding the damage to the surrounding paravertebral muscles and joint capsule,and effectively alleviating postoperative lumbar and back pain.