两种入路椎弓根螺钉固定结合术后康复锻炼治疗胸腰椎骨折

目的对比肌间隙入路与传统后正中入路椎弓根螺钉固定结合术后康复锻炼治疗胸腰椎骨折的临床疗效。方法 2009年8月至2012年7月收治的胸腰椎骨折患者190例,随机分为两组：肌间隙入路组及传统后正中入路组,行椎弓根螺钉内固定并结合术后康复锻炼治疗,分析手术时间、出血量、术后耐受腰背肌锻炼时间、术后下地时间以及术前、术后1周、术后1个月疼痛视觉模拟量表评分（VAS）、术后半年及1年随访腰背痛日本骨科协会评估治疗分数（JOA）评分和术前、术后及末次Cobb角的变化。结果椎旁肌间隙入路组除1年随访JOA评分外其余指标均明显优于常规入路（P〈0.05）,两组术后与术前Cobb角变化差异有统计学意义（P〈0.05）,但组间对比差异无统计学意义。结论经多裂肌和最长肌间隙入路椎弓根螺钉固定治疗无神经症状型胸腰椎骨折,能早期康复锻炼,具有创伤小,恢复快,耐受好,腰背痛发生少等优点,是一种实用的治疗方法。

Pedicle screw fixtion for the thoracolumbar fracture through different lumbar posterior approaches combined with postoperative rehabilitation exercise

Objective To evaluate the clinical outcomes of thoracolumbar fractures treated by pedicle screw fixtion via the intrasacrospinal muscular approach combined with postoperative rehabilitation exercise and compare this method with the conventional approach.Methods From August 2009 to July 2012,a total of 190 cases of thoracic and lumbar spine fractures with noneurological symptoms were included in this study.The patients were divided into two groups：intrasacrospinal muscular approach group and conventional approach group.Operative time,blood loss,the exercise starting time after operation,duration of recumbence,preoperative and postoperative VAS score and Cobb angle,and the low back pain JOA score after six months and one year were analyzed.Results There was significant difference in operative time,blood loss,the exercise starting time after operation,duration of recumbence,postoperative VAS score,and the low back pain JOA score after six months between intrasacrospinal muscular approach group and conventional approach group（P0.05 for all）. Postoperative Cobb angle showed significant difference before and afer operation（P0.05）,but there was no significant difference between two groups.The low back pain JOA score after one year showed no statistically significant difference between two groups.Conclusion The pedicle screw fixtion for the thoracolumbar fracture via the intrasacrospinal muscular approach combined with the low back exercise is a practical comprehensive method.