后路肌间隙入路在治疗胸腰椎疾患中的应用

目的对比经椎旁肌间隙入路与传统后正中入路在胸腰椎后路手术上的疗效。方法选取我院2008年6月～2011年10月,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患者67例,行单节段椎弓根钉棒系统撑开复位内固定及拆除内固定手术。随机分为2组:传统后正中入路组(n=31)和椎旁肌间隙入路组(n=36)。比较2组的手术时间、术中出血量及术后VAS疼痛度。结果所有患者获得随访,随访时间为3周。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);椎旁肌间隙入路组在手术时间、术中出血量、术后引流量上明显少于传统入路组,在疼痛VAS评分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。

Application of paraspinal muscle space approach in the treatment of thoracic and lumbar disorders

Objective To compare the clinical results between paraspinal muscle space approach and conventional posterior midline approach in thoracolumbar posterior surgery.Methods From Jun 2008 to Oct 2011,67 patients who had single-segment thoracolumbar vertebral compression or burst fractures without neural syndromes underwent reposition and internal fixation by the screw-rod system or the surgery of removal interal fixation.The patients were divided into 2 groups randomly:conventional posterior midline approach group(n=31)and paraspinal muscle space approach group(n=36).And the data between 2 groups were compared,such as operation time,blood loss,visual analog scale(VAS)scores,etc.Results All patients were followed up for 3 weeks.The differences of postoperative correction rate of Cobb’s angle and accuracy of pedicle screw placement between 2 groups weren’t statistically significant(P>0.05).The operation time,blood loss and postoperative volume of drainage of the paraspinal muscle space approach group were less than those of the posterior midline approach group.The postoperative VAS score of the paraspinal muscle space approach group were lower than those of the posterior midline approach group.Conclusion The paraspinal muscle space approach is a better way than the posterior midline approach for thoracolumbar posterior surgery,which can get less trauma,less injury of paraspinal muscle and more relief of postoperative low back pain.