两种不同入路治疗无神经症状胸腰椎骨折的病例对照研究

目的:探讨两种不同手术入路治疗无神经症状胸腰椎骨折的临床疗效。方法:自2008年1月至2009年12月,对采用经后正中入路(A组,20例)和椎旁肌间隙入路(B组,20例)治疗的无神经损伤的胸腰椎骨折40例进行回顾性分析,男13例,女27例,年龄26～61岁,平均46岁。所有患者均接受相同的脊柱后路内固定系统(Basis TM)。40例患者平均随访16个月(10～27个月)。分析内容包括手术时间、术中出血量、术后引流量、术后卧床时间、术后24 h及72 h疼痛视觉模拟评分(VAS)、术后Cobb角纠正率、椎体塌陷纠正率。结果:术后患者均无明显并发症,两组患者术后Cobb角纠正率,椎体塌陷纠正率比较无统计学差异;经椎旁肌间隙入路组在手术时间、术中出血量、术后引流量、术后卧床时间、术后24 h及72 h的VAS等方面均优于后正中入路组。结论:经椎旁肌间隙入路治疗无神经症状胸腰椎骨折具有创伤小、出血少、术后恢复快等优点,但有神经症状或椎管内占位超过1/3者慎用此入路。

Case-control study on two different approaches for the treatment of thoracolumbar fracture without neurological symptoms

Objective:To investigate the clinical effects of two surgical approaches for the treatment of thoracolumbar fracture without neurological symptoms. Methods:From January 2008 to December 2009,40 cases with thoracolumbar fractures without neurological symptoms treated by surgery were respectively analyzed. Among the patients,there were 13 males and 27 females,with an average age of 46 years( ranged,26 to 61 years). Twenty patients in group A treated through posterior median approach;twenty patients in group B were treated through paraspinal muscle approach. All the patients were received the same posterior spinal internal fixation(Sofamor Inc(BasisTM)). Operating time,blood loss,postoperative drainage,postoperative bed time,VAS score 24 and 72 hours after operation,postoperative Cobb angle correction rate,correction rate of vertebral collapse were analyzed. Results:There were no significant difference in postoperative Cobb angle correction rate and vertebral collapse rate(P<0.05);while the index such as operating time,blood loss,postoperative drainage,postoperative bed time and VAS score 24 h and 72 h after operation in group B is better than group A. Conclusion:Treatment of thoracolumbar fracture through posterior median approach has an advantage of minimal invasive,less bleeding and rapidly recovery,but the patients with neural symptoms and intraspinal occupying more than 1/3 is not suggest.