经椎旁肌入路治疗胸腰段椎体骨折

目的 探讨经椎旁肌入路内固定治疗胸腰段椎体骨折的方法和临床疗效.方法 2005年6月至2006年8月,共62例无神经损伤表现的胸腰段椎体骨折患者接受手术治疗.男48例,女14例;平均年龄45.2岁(21～58岁).T12骨折21例,L1骨折24例,L2骨折17例;依据Denis骨折分型,压缩型骨折15例,余下的47例为爆裂型骨折,并且椎管占位均小于1/3,所有骨折后柱均完整.随机选取其中34例患者接受经椎旁肌入路的手术治疗,其余28例患者则采用传统的后正中入路治疗.经椎旁肌人路沿最长肌与多裂肌间隙进入,保留椎旁肌肉的完整性,既可行椎弓根螺钉的内固定操作,也可行横突尖或关节突的植骨融合.术后一般无须放置引流管,术后早期患者即可佩带支具下床行走.结果 通过围手术期疗效观察,发现经椎旁肌入路手术与传统后正中手术相比较在手术时间上差异不大,但在出血量、术后引流量、卧床时间以及术后疼痛视觉模拟评分(visual analogue scale,VAS)等方面都具有显著的优势,差异有统计学意义(P＜0.05).截至2007年8月,共56例患者获得随访,平均随访时间18.6个月(12～26个月),所有随访患者的骨折椎体均获得愈合,无一例发生骨折复位丢失及内固定物的松动、断裂,两组间远期疗效无差异.结论 经椎旁肌入路内固定治疗胸腰段椎体骨折具有创伤小、出血少、术者操作简单、术后患者恢复快等优点.

Surgical treatment of thoracolumbar fractures through the approach between para-vertebral muscle

Objective To investigate the methods and clinical outcome of the operative treatment of thoracolumbar fractures through the approach between the para-vertebral muscle(PVM).Methods From June 2005 to August 2006, a total of 62 patients, who suffered from thoracolumbar fractures with neurological intact, underwent surgical treatment,including 48 males and 14 females with an average age of 45.2 years(range,21-58 years).According to the injured location,21 T12 fractures,24 L1 fractures and 17 L2 fractures were involved,however,as to Denis fracture classification,the study comprised 15 compression fractures and 47 burst fractures with posterior column intact.Then 34 cases were selected on random to receive treatment through the above approach,the other 28 cases underwent the traditional procedure,respectively.During the operation, the interval between the longissimus and multifidis muscle was undermined following the incision of posterior midline, not only can it make the fixing of pedicle screws easier and spare the PVM, but help to allow the bone graft be inserted into facet ioints.No drainage was needed routinely and the patients can mobilize with brace earlier post-operatively.Results Through comparison between the above two groups earlier post-operatively,the results confirmed that the new approach had obvious advantage over traditional method in blood lOSS,drainage,duration of recumbence and visual analogue scale(VAS),and the difference was of statistical significance (P＜0.05), although the time-consuming was almost the same between the two approaches.Till August 2007, 56 patients were available and all got bone union on final follow up with duration from 12 to 26 months (mean, 18.6 months).Neither reduction loss nor loosening or breakage of the fixator had occurred in two groups.Conclusion This technique of operative treatment through the approach between the PVM is much less invasive and applicable for the thoracolumbar fractures,which can reduce the blood loss, accelerate the rehabilitation simultaneously.