经椎旁肌入路治疗胸腰段椎体骨折

摘要

目的：探讨经椎旁肌入路内固定治疗胸腰段椎体骨折的治疗效果。方法2010年12月至2014年2月行椎弓根钉棒系统撑开复位内固定手术治疗73例单节段胸腰椎压缩性或爆裂性骨折但无神经症状不需行椎管减压的患者。随机采用传统后正中入路38例，经椎旁肌间隙入路35例。比较2组的手术时间、术中出血量、术后引流量、卧床时间、视觉模拟量表（ visual analog scale ，VAS）评分，椎体高度丢失情况以及Cobb角度变化。结果所有患者均获得随访，平均随访时间16．7个月（12～36个月）。手术时间、术后Cobb角矫正率2组间差异无统计学意义（P＞0．05）。肌间隙入路组在术中出血量、术后引流量上明显少于传统入路组（P＜0．05）；肌间隙入路组在VAS评分、血肌酸激酶同工酶水平升高程度上明显低于传统入路组（ P＜0．05）。所有随访患者的骨折椎体均获得愈合，无一例发生骨折复位丢失及内固定物的松动、断裂，2组间远期疗效无差异。结论椎旁肌间隙入路与传统后正中入路相比，在治疗不需减压的胸腰椎骨折上，具有创伤小、对椎旁肌的损伤少及术后腰背部疼痛缓解明显的优点。%Objective To assess the efficacy of fixed treatment of thoracolumbar fractures through the approach be -tween the para-vertebral muscles .Methods A total of 73 patients admitted into our hospital from December 2010 to February 2014 due to single-segment of thoracolumbar compression fracture or burst fractures without neural syndromes were enrolled into the current study , who underwent open reduction and internal fixation by the screw -rod system.Then these patients were randomly divided into two groups according to their surgical approaches used :a posterior midline ap-proach in 38 patients and a para -vertebral approach in 35 patients .Both groups were compared for surgical time , blood loss, post-operative drainage, duration of immobilization, visual analog scale (VAS) scores, vertebral height and the Cobb′s angle.Results All patients were followed up from 12 to 36 months, with an average of 16.7 months.No statisti-cal difference was found in surgical time and the correction rate of postoperative Cobb ′s angle (P>0.05).The para-vertebral approach group showed remarkably reduced blood loss and less volumes of postoperative drainage than the poste -rior midline approach group (P<0.05).The postoperative VAS score and the level of CK -MB were obviously less in the para-vertebral approach group than those in the posterior midline approach group (P<0.05).All patients had bone union, without reduction loss , and loosening or breakage of the fixator .Both groups had similar long -term efficacy. Conclusion Compared with the posterior midline approach , the paraspinal approach has advantages in small incision , less injury of paraspinal muscles and obvious remission of postoperative low back pain during treatment of thoracolumbar fractures without decompression .