经多裂肌间隙入路与后正中入路椎弓根内固定术治疗胸腰椎骨折患者的效果比较

Comparison of effects of pedicle internal fixation through multifidus intermuscular approach and posterior median approach in treatment of patients with thoracolumbar fractures

目的:比较经多裂肌间隙入路与后正中入路椎弓根内固定术治疗胸腰椎骨折患者的效果。方法:选取2021年4月至2023年4月该院收治的89例胸腰椎骨折患者进行前瞻性研究,按随机数字表法将其分为对照组44例与观察组45例。对照组采用经后正中入路椎弓根内固定术治疗,观察组采用经多裂肌间隙入路椎弓根内固定术治疗。比较两组手术相关指标水平,手术前后腰椎功能[Oswestry功能障碍指数(ODI)]评分、复位指标(伤椎前缘高度比、Cobb角)水平、创伤因子指标[肌酸激酶(CK)、肌红蛋白(Myo)、乳酸脱氢酶(LDH)]水平,以及并发症发生率。结果:观察组手术时间、切口长度均短于对照组,术中出血量、术中透视次数均少于对照组,差异有统计学意义(P<0.05);两组术后引流量比较,差异无统计学意义(P>0.05);术后6个月,两组ODI评分均低于术前,Cobb角均小于术前,伤椎前缘高度比均高于术前,但组间比较,差异均无统计学意义(P>0.05);术后3 d,两组血清CK、Myo、LDH水平均高于治疗前,但观察组低于对照组,差异有统计学意义(P<0.05);两组螺钉松动、骨折椎体复位高度丢失、感染发生率比较,差异均无统计学意义(P>0.05);观察组腰背肌疼痛发生率低于对照组,差异有统计学意义(P<0.05)。结论:经多裂肌间隙入路与后正中入路椎弓根内固定术治疗胸腰椎骨折患者的效果相当,但经多裂肌间隙入路椎弓根内固定术缩短手术时间、切口长度,减少术中出血量、术中透视次数,以及降低创伤因子指标水平和腰背肌疼痛发生率的效果优于后正中入路椎弓根内固定术。

Objective:To compare effects of pedicle internalfixation through multifidus intermuscular approach and posterior median approach in treatment of patients with thoracolumbar fractures.Methods:A prospective study was conducted on 89 patients with thoracolumbar fractures admitted to this hospital from April 2021 to April 2023.They were divided into control group(44 cases)and observation group(45 cases)according to the random number table method.The control group was treated with pedicle internalfixation through posterior median approach,while the observation group was treated with pedicle internalfixation through multifidus intermuscular approach.The levels of surgery-related indicators,the lumbar function[Oswestry dysfunction index(ODI)]scores,the reduction indicators(anterior vertebral height ratio,Cobb angle)levels,and the trauma factor indicators[creatine kinase(CK),myoglobin(Myo),lactate dehydrogenase(LDH)]levels before and after the surgery,and the incidence of complications were compared between the two groups.Results:The operation time,the incision length in the observation group were were shorter than those in the control group,the intraoperative blood loss and the intraoperativefluoroscopy times were less than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the postoperative drainage volume between the two groups(P>0.05).6 months after the surgery,the ODI score of the two groups were lower than those before the surgery,the Cobb angle of the two groups were smaller than those before the surgery,and the anterior vertebral height ratio levels were higher than those before the surgery;however,there were no significant differences between the two groups(P>0.05).3 days after the surgery,the levels of serum CK,Myo and LDH in the two groups were higher than those before the treatment,but those in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence of low back muscle pain in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusions:The pedicle internalfixation through multifidus intermuscular approach and posterior median approach in the treatment of the patients with thoracolumbar fractures is similar,but the former can reduce the operation time,the incision length,the intraoperative blood loss,the intraoperativefluoroscopy times,the trauma factor index levels and the incidence of low back muscle pain.Moreover,it is superior to pedicle internalfixation through posterior median approach.