经椎旁肌间隙入路治疗胸腰椎骨折

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1、·98·脊柱外科杂志，2011年4月，第9卷第2期JSpinalSurg，April2011，Vol9，No2·临床研究·经椎旁肌间隙入路治疗胸腰椎骨折张文捷，张亮，赵春明【摘要】目的对比经椎旁肌间隙入路与传统后正中入路在治疗胸腰椎骨折上的疗效。方法2003年5月～2009年1月，行单节段椎弓根钉棒系统撑开复位内固定手术治疗50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。患者随机平均分为2组(n=25):传统后正中入路组和椎旁肌间隙入路组。比较2组的手术时间、术中出血量、视觉模拟量表(visualanalogscale，VAS)评分等资料。结果所有患

2、者获得随访，随访时间为6个月。手术时间、术后Coob角矫正率及椎弓根钉置入准确率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;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。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。【关键词】胸椎;腰椎;脊柱骨折;内固定器【中图分类号】R683．2【文献标志码】A【文章编号】1672-2957(2011)02-0098-04【DOI】doi:10．3969/j．issn．1

3、672-2957．2011．02．009SurgicaltreatmentofthoracolumbarfracturesthroughparaspinalapproachZHANGWen-jie，ZHANGLiang，ZHAOChun-ming．DepartmentofOrthopaedics，TaizhouPeople’sHospital，Taizhou225300，China【Abstract】ObjectiveTocomparetheclinicalresultsbetweenparaspinalapproachandconventionalposteriormi

4、dlineapproachfortreatingthethoracolumbarfracture．MethodsFromMay2003toJanuary2009，50patientswithsingle-segmentthoracolumbarvertebralcompressionorburstfractureswithoutneuralsyndromesunderwentrepositionandinternalfixationbythescrew-rodsystem．Thepatientsweredividedinto2groups(n=25)randomly:co

5、nventionalposteriormidlineapproachgroupandparaspinalapproachgroup．Andthedatabetween2groupswerecompared，suchasoperationtime，bloodloss，vis-ualanalogscale(VAS)scores，etc．ResultsAllpatientswerefollowedupfor6months．Thedifferencesofoperationtime，postoperativecorrectionrateofCobb’sangleandaccura

6、cyofpediclescrewplacementbetween2groupsweren’tstatisticallysignificant(P＞0．05)．Thebloodlossandpostoperativevolumeofdrainageoftheparaspinalapproachgroupwerelessthanthoseoftheposteriormidlineapproachgroup．ThepostoperativeVASscoreandtheincreaseddegreeofCK-MBoftheparaspi-nalapproachgroupwerel

7、owerthanthoseoftheposteriormidlineapproachgroup．ConclusionTheparaspinalapproachisanbetterwaythantheposteriormidlineapproachfortreatingofthoracolumbarfracturesthathavenoneedofdecompression，whichcangetlesstrauma，lessinjuryofparaspinalmuscleandmorereliefofpostoperative