不同手术入路治疗无神经损伤的胸腰椎骨折的近期疗效观察

【摘要】〓目的〓比较椎旁肌间隙入路和后正中入路椎弓根螺钉内固定治疗无神经损伤的胸腰椎骨折的近期疗效。 方法〓选择2009年4月~2013年4月50例无神经损伤的胸腰椎骨折患者,均在全身麻醉下行椎弓根螺钉内固定+伤椎植骨术,随机分为观察组(椎旁肌间隙入路)和对照组(后正中入路)各25例。记录两组术中出血量、手术时间、术后引流量和住院时间,比较术前、术后1年两组VAS评分、椎体压缩率和Cobb角变化。结果〓观察组术中出血量、手术时间、术后引流量和住院时间明显少于对照组(P<0.05)。术前两组VAS评分、椎体压缩率和Cobb角比较差异无统计学意义(P>0.05),术后1年,两组VAS评分、椎体压缩率和Cobb角显著降低(P<0.05),且观察组VAS评分明显低于对照组(P<0.05),但两组椎体压缩率和Cobb角比较差异无统计学意义(P>0.05)。结论〓椎旁肌间隙入路椎弓根螺钉内固定+伤椎植骨术治疗无神经损伤的胸腰椎骨折手术创伤小,术后康复快,近期疗效满意。

The short-term efficacy of different surgical approaches on thoracolumbar fracture without nerve injury

Objective To compare the short term efficacy of pedicle screw fixation with intra- sacrospinal muscular approach and conventional approach for treating thoracolumbar fractures without nerve injury. Methods Fifty cases with thoracolumbar fractures without nerve injury undergoing fractured vertebral pedicle screw fixation and bone grafting from April 2009 to April 2013 were randomized into the observation group （paraspinal muscle approach） and the control group （conventional approach） with 25 cases in each group. Blood loss, operative time, postoperative drainage and hospitalization time were recorded in two groups, and preoperative VAS scores and postoperative VAS scores after one year, vertebral compression ratio and Cobb angle were compared in two groups. Results Blood loss, operative time, postoperative drainage, and hospital stay in the observation group were significantly less than those in the control group （P〈0.05）. There were no significant difference in preoperative VAS score, vertebral compression ratio and Cobb angle between two groups （P〉0.05）, and these were decreased one year after operation in two groups. VAS score in observation group was significantly decreased than that in control group, but the difference of vertebral compression ratio and Cobb angle between the two groups was no statistically significant （P〉O.05）. Conchmion In treating thoracolumbar fractures without injured nerve, the paraspinal muscle pedicle screw fixation plus vertebral bone grafting was less injury, faster postoperative recovery and better short term efficacy.