目的：研究椎旁肌间隙入路和传统后正中入路治疗无神经症状的胸腰椎骨折的临床疗效及对椎旁肌的影响。方法2011年7月～2012年7月我院骨科预行椎弓钉短节段内固定术的胸腰椎骨折患者82例，随机分成2组，椎旁肌间隙入路39例（A组），传统后正中入路43例（B组），对两组的临床疗效指标进行统计分析；术后1年取出内固定时切取少量椎旁肌行HE染色做组织切片，对两组切片进行观察比较。结果两组手术时间、术中出血量、切口内残腔体积、术后引流量、术后视觉模拟评分（visual analogue scale，VAS）评分，A组均低于B组，差异有统计学意义（P＜0.05）。两组手术切口长度无显著差异（P＞0.05）。术后24、72h的肌酸磷酸激酶（Creatine kinases，CK）值，A组极显著低于B组（P＜0.01），而术后1周两组CK值恢复至正常水平，差异无统计学意义（P＞0.05）。两组手术方式均能明显矫正后凸角和压缩椎体前缘高度，术后椎体前、后缘高度与伤椎上、下椎体的前、后缘高度平均值比和Cobb角与术前相比，无显著差异（P＞0.05）。组织切片示传统后正中入路组椎旁肌肌纤维萎缩变细甚至消失、排列紊乱、肌丝崩解，肌纤维间瘢痕形成，肌纤维脂肪沉积；而椎旁肌间隙入路组肌纤维无明显萎缩、排列有序正常，肌纤维未见明显退变，无瘢痕形成，无脂肪沉积。结论经椎旁肌间隙入路短节段椎弓根钉固定术治疗无神经症状的胸腰椎骨折，能有效恢复椎体高度和纠正后凸角度，与传统后正中入路相比，具有手术创伤小、出血量少、手术时间短，不损伤椎旁肌，减少术后腰背肌疼痛等优点。%Objective To compare the clinical outcome and the impacts of paraspinal approach and con-ventional approach in treating thoracolumbar fractures without neurological symptoms .Methods From Jul.2011 to Jul.2012,eighty-two patients who suffered from thoracolumbar fractures without neurological symptoms and need posterior short-segment pedicle screws fixation were included .These patients were randomly divided into 2 groups:paraspinal approach group (39 cases) and conventional approach group (22 cases).Clinical effects were accessed and measured;the pathological changes of paravertebral muscle tissue which was resected at 1 year after operation were observed and compared between the two groups .Results The surgical time,surgical blood loss,volume of re-sidual cavity,surgical draining loss,postoperative VAS (visual analogue scale) scores were lower in the paraspinal approach group than those in the conventional approach group (P<0.05).There was no difference in the length of incision between the two groups (P>0.05).The CK(Creatine kinases)value at 2 days and 3 days postoperatively was significantly lower in the paraspinal approach group than that in the conventional approach group (P<0.01). However,the CK(Creatine kinases)value recovered to normal level at 1 week postoperatively,exhibiting no statistical difference(P>0.05).Both surgical methods could obviously correct the kyphosis angle and the compression verte -bral height.There was no significant difference in the average height of anterior and posterior border of vertebral body and the Cobb angle between postoperatively and preoperatively (P>0.05).The pathological observations showed atrophy of muscle,formation of scar and deposition of fat in the conventional approach group ,whereas in the paraspinal approach group ,these conditions were notably alleviated .Conclusion The paraspinal approach for trea-ting thoracolumbar fractures without neurological symptoms can effectively recover the height of vertebral body and correct the kyphosis.Compared with the conventional approach ,the paraspinal approach has the advantages of mini-invasiveness,less bleeding,short surgical time,no injury to the paraspinal muscles and less pain to the back muscle .
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