不同入路方案下胸腰椎骨折患者的外科疗效对比

Com Parison of surgical treatment of Patients with thoracolumbar fracture with different a PProach

目的 :探究经椎旁肌间隙入路与微创经皮入路椎弓根螺钉内固定治疗胸腰椎骨折的临床效果。方法 :选取2011年1月~2015年12月于我院接受治疗的116例胸腰椎骨折患者,根据随机数表法将患者分为椎旁组与微创组,椎旁组采用椎旁肌间隙入路椎弓根螺钉内固定手术,微创组采用微创经皮椎弓根螺钉内固定手术。比较两组患者术后引流、出血量,住院时间,切口长度,手术时间等围手术期情况,对两组患者气胸、膈疝、内脏器官的损伤等手术入路并发症发生率进行比较,统计两组患者疼痛评分情况。结果 :椎旁组患者住院时间为(8.1±2.1d)d高于微创组(6.2±1.3)d,椎旁组手术时间为(54.3±4.7)min明显低于微创组的(78.5±5.2)min,差异均具有统计学意义。椎旁组治疗后2周、12个月、末次VAS评分分别为(5.3±0.4)分、(2.6±0.8)分、(2.0±0.4)分,与术前(8.8±0.7)分相比明显降低,差异具有统计学意义;微创组治疗后2周、12个月、末次VAS评分分别为(5.7±0.3)分、(2.4±0.7)分、(1.7±0.7)分,与术前(9.1±0.6)分相比明显降低,差异具有统计学意义。结论 :经椎旁肌间隙入路与微创经皮入路对胸腰椎骨折患者的外科具有出血量少、手术并发症发生率低、可明显缓解患者术后疼痛等优点,但前者在手术时间上更具优势。

Objective To explore the clinical effect of the treatment of thoracolumbar fractures by the approach of the ad-jacent muscle gap approach and the minimally invasive percutaneous fixation of pedicle screw fixation. Methods 116 patients with thoracic and lumbar vertebra were selected from January 2011 to December 2015 in our hospital for treatment of fractures, according to the random number table method, the patients were divided into paravertebral group and minimally invasive group, paravertebral group with paraspinal approach pedicle screw fixation, minimally invasive group with minimally invasive percuta-neous pedicle screw fixation. Compared two groups of patients with postoperative drainage, the amount of bleeding, hospitaliza-tion time, incision length, operative time, perioperative complications occurred, the two groups of patients with pneumothorax, diaphragmatic hernia, visceral organ injury and other complications of surgical approach were compared, statistical score of two groups of patients with pain. Results Paravertebral hospitalization time was (8.1 ± 2.1d) d higher than the minimally invasive group (6.2 ± 1.3) d, paravertebral operative time was (54.3 ± 4.7) in minimally invasive group were lower than min (78.5 ± 5.2) min, the differences were statistically significant. Paravertebral groups after 2 weeks and 12 months, the last VAS scores were (5.3 ± 0.4), (2.6 ± 0.8), (2 ± 0.4), and preoperative (8.8 ± 0.7) phase ratio decreased significantly, the difference was statistically significant; minimally invasive group after 2 weeks of treatment, the last 12 months, VAS scores were (5.7 ± 0.3), (2.4 ± 0.7), (1.7 ± 0.7), and preoperative (9.1 ± 0.6) phase ratio decreased significantly, the difference was statistically significant. Con-clusion Paraspinal approach and minimally invasive percutaneous approach with less bleeding, postoperative complication rate is low, can significantly relieve postoperative pain and other advantages of the patients with thoracolumbar fracture surgery, but the former has more advantage in operation time.