经椎旁肌间隙入路治疗胸腰椎骨折

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（visual analog scale,VAS）评分等资料。结果所有患者获得随访,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。

Surgical treatment of thoracolumbar fractures through paraspinal approach

Objective To compare the clinical results between paraspinal approach and conventional posterior midline approach for treating the thoracolumbar fracture.Methods From May 2003 to January 2009,50 patients with single-segment thoracolumbar vertebral compression or burst fractures without neural syndromes underwent reposition and internal fixation by the screw-rod system.The patients were divided into 2 groups（n=25） randomly： conventional posterior midline approach group and paraspinal approach group.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 6 months.The differences of operation time,postoperative correction rate of Cobb＇s angle and accuracy of pedicle screw placement between 2 groups weren＇t statistically significant（P0.05）.The blood loss and postoperative volume of drainage of the paraspinal approach group were less than those of the posterior midline approach group.The postoperative VAS score and the increased degree of CK-MB of the paraspinal approach group were lower than those of the posterior midline approach group.Conclusion The paraspinal approach is an better way than the posterior midline approach for treating of thoracolumbar fractures that have no need of decompression,which can get less trauma,less injury of paraspinal muscle and more relief of postoperative low back pain.