肌间隙入路与后正中入路手术治疗胸腰椎骨折的疗效

摘要

Objective To compare the clinical efficacy of muscle gap approach and posterior middle approach in surgical treatment of thoracolumbar fractures.Methods Thirty-six patients with thoracolumbar fractures were treated with pedicle screw internal fixation via muscle gap approach(group A,18 cases) or posterior middle approach(group B,18 cases).The operative time,intraoperative blood loss,postoperative drainage,anterior body height ratio Cobb''s angle of injured vertebra,and postoperative VAS pain score on the 7th day after operation were compared between two groups.Results The surgeries in all patients were successful.The patients were followed up for 10 to 24 months,which showed no postoperative infection,nerve injury,break of internal fixation and other complications.Compared with group B,group A had shorter operation time,less intraoperative blood loss,less postoperative drainage and lower postoperative VAS pain score(P<0.05).Compared with before,the anterior body height ratio and Cobb''s angle of injured vertebra were all improved significantly after operation in two groups(P<0.05).Conclusion Compared to posterior middle approach,pedicle screw internal fixation via muscle gap approach in treating thoracolumbar fracture has the advantages of less trauma and bleeding,simple operation and quick recovery.%目的 比较肌间隙入路与后正中入路治疗胸腰椎骨折的疗效.方法 胸腰椎骨折患者36例采用椎弓根钉内固定治疗;其中,A组18例采用肌间隙入路,B组18例行后正中入路.比较两组手术时间、术中出血量和术后引流量,测量手术前后伤椎前缘高度比及Cobb角及术后第7天VAS疼痛评分.结果 两组手术均顺利完成,获得随访10～24个月,无术后感染、神经损伤、内固定断裂等并发症发生.与B组比较,A组手术时间短、术中出血量和术后引流量少,术后VAS疼痛评分低(P<0.05).与术前相比,两组术后伤椎前缘高度比及Cobb角均改善(P<0.05).结论与后正中入路比较,经椎旁肌间隙入路椎弓根钉内固定治疗胸腰椎骨折具有创伤小、出血少、术中操作简单、术后患者恢复快等优点.