多段小切口椎旁肌间隙入路治疗胸腰段椎体压缩性骨折

目的对比研究多段小切口椎旁肌间隙入路和传统后正中入路治疗胸腰段椎体压缩性骨折的疗效。方法回顾性分析我科于2013年6月至2014年8月手术治疗外伤所致48例胸腰段椎体压缩性骨折病例,其中21例采用传统后正中入路治疗(后正中入路组),另外27例采用多段小切口椎旁肌间隙入路治疗(椎旁肌间隙入路组)。记录两组手术时间、术中出血量、术后引流量;分别于术前及术后1、3和5 d检测两组患者血清肌酸激酶值;术前和术后3 d常规拍摄X线片,比较两组Cobb角矫正率;应用视觉疼痛模拟评分(visual analogue scale,VAS)评估患者术前和术后疼痛情况。结果所有患者经治疗后临床症状明显缓解,功能恢复较好。两组术前指标差异无统计学意义。椎旁肌间隙入路组手术时间、术中出血量、术后引流量均少于后正中入路组(P<0.01);VAS评分术后两组均较术前明显改善,椎旁肌间隙入路组优于后正中入路组(P<0.01);血清肌酸激酶值术后两组均有不同程度升高,并逐渐降低,椎旁肌间隙入路组较后正中入路组下降快(P<0.01);Cobb角术后两组均较术前明显好转(P<0.01)。结论对于部分类型胸腰段骨折,多段小切口椎旁肌间隙入路可以作为一种手术入路选择,疗效明显,但需要严格掌握手术适应证。

Application of paraspinal muscle space approach with multi-segment small incision in treatment of thoracolumbar compression fracture of vertabral body

Objective: To investigate the paraspinal muscle space approach with multi-segment small incision and conventional posterior midline approach in treatment of thoracolumbar compression fracture of vertabral body. Methods: From June 2013 to August 2014, a total of 48 patients with traumatic thoracolumbar fracture were treatmented surgically, while 24 cases were underwented conventional posterior midline approach (group A) and others were contancted with paraspinal muscle space approach with multi-segment small incision(group B).Compared with surgical indicators in the two groups including the amount of intraoperative bleeding and postoperative bleeding, operative time. The serum creatine kinase values were detected preoperative and on postoperative 1,3,5 d in patients. Cobb angle correction rate were compared between the two groups in preoperative and postoperative X ray.The visual pain analog score (VAS) was assessmented in patients with preoperative and postoperative pain. Results: The clinical symptoms of all patients were relieved after treatments. All patients get better functional recovery.The preoperative indicators did not show significant difference between both groups.The indicators including the amount of intraoperative bleeding and postoperative bleeding, operative time in group B were lower than group A (P <0.01). Postoperative serum creatine kinase values in both groups increased to varying degrees,and gradually reduced,and rapid declined in group B than group A. Cobb angle correction rate of postoperative patients in both groups improved significantly. There was significant difference in VAS score in the two groups after operation lower compared with preoperative groups respectively (P <0.01), and group B was better than group A (P <0.01). Conclusion: For some types of thoracolumbar fractures, the paraspinal muscle space approach with multi-segment small incision can be used as a surgical approach option, with significant effect, but it need to control surgery indications strictly.