腰椎后路不同显露方式对椎旁肌影响的临床研究

目的比较胸腰椎骨折后路内固定两种不同显露方式对椎旁肌的影响。方法将2010年3月至2011年8月期间入院的75例病例分成两组：A组40例,肌间隙入路显露,B组35例,传统后入路显露。搜集数据：手术时间、术中出血量;血肌酸激酶值;椎体前后缘高度、Cobb角及CT横截面上椎旁肌面积;VAS疼痛、Oswestry功能障碍评分等。结果两组手术时间、术中出血、术后4天及末次随访VAS疼痛评分、术后Oswestry功能障碍指数、术后第1、3天血肌酸激酶值、术后及末次随访椎旁肌面积等方面比较差异有统计学意义（P〈0.05）,A组优于B组。结论椎旁肌间隙入路显露方式与传统后入路显露方式比较,具有手术操作简单、术中出血少、对椎旁肌影响小,从而减少术后腰背痛残留,减轻患者痛苦,利于胸腰椎骨折患者康复,是临床上胸腰椎骨折后入路显露方式的最佳选择。

Clinical study of the impact of different lumbar posterior approachs on paravertebral muscles

Objective To assess the effect on paravertebral muscles of two thoracolumbar posterior approachs in treatment of thoracolumbar fractures by internal fixation.Methods From March 2010 to August 2011,75 cases with thoracolumbar fractures were included.40 cases were treated with thoracolumbar vertebra-side muscle clearance(Group A) and 35 cases with conventional approach(Group B).Operative time,blood loss,the serum Creatinine Kinase(CK),vertebral body height,Cobb angle and the cross-sectional area of paravertebral muscles by CT evaluation,pain degree(visual analogue score,VAS) and Oswestry disability questionnaire were analyzed.Results There were signifficant differences(P<0.05) on operative time,blood loss,the 4th day postoperatively and final follow-up back pain,Oswestry disability index,serum level of Creatinine Kinase at the 1st and 3rd day postoperatively,postoperative and final follow-up paraspinal muscle area between two groups.Group A is better than B.Conclusion Compared with conventional approach,thoracolumbar vertebra-side muscle clearance approach has the advantages of handy operate,less blood loss and smaller impact on paravertebral muscles.It could promote heal,reduce residual low back pain and patient pain,help patients with thoracolumbar fractures rehabilitation.It is the best way for clinical treatment of thoracolumbar fractures.