胸腰段骨折经肌间隙入路与传统入路内固定的比较研究

目的 前瞻性对比研究Wiltse经多裂肌和最长肌间隙入路与传统入路在胸腰段椎体骨折椎弓根钉-棒系统复位内固定术中对脊旁肌损伤的差异.方法 自2004年6月至2006年12月,采用后路椎弓根钉-棒系统撑开复位内固定术治疗胸腰段椎体骨折患者47例,ASIA分级均为E级.随机采用脊旁肌间隙入路22例,男16例,女6例,年龄19～49岁,平均37.6岁;传统骶棘肌剥离入路25例,男18例,女7例,年龄16～65岁,平均40.1岁.患者术前及术后1、3、5、7d测定肌酸激酶水平.所有患者均获得随访,术前1天及术后1、6个月进行视觉模拟数字法疼痛评分,并在末次随访时行多裂肌肌内静息肌电图评估.结果 肌间隙入路组与传统入路组手术时间无明显差异;肌间隙入路组术中平均出血明显低于传统入路组;术后肌酸激酶水平均明显低于传统入路组.肌间隙入路组与传统入路组术前1天VAS评分无明显差异,而术后1、6个月VAS评分均明显低于传统入路组.肌间隙入路组术后肌电图未发现失神经电位;而传统入路组术后肌电图存在明显失神经纤颤电位.结论 肌间隙入路相比开放入路具有置钉容易,术中创伤小,术后恢复快和对脊旁肌的损伤、干扰少等优点.

Comparison study between Wiltse paraspinal approach and conventional approach for thoracolum-bar vertebral fracture

Objective To determine the difference of paraspinal muscle injury between Wiltse paraspinal approach and conventional approach for the thoracolumbar vertebral fracture with open reduction and internal fixation. Methods A total of 47 patients with thoracolumbar vertebral fracture(ASIA E) under-went posterior open reduction and internal fixation from June 2004 to December 2006. Randomly, 22 pa-tients adopted Wiltse paraspinal approach, including 16 males and 6 females with the mean age of 37.6 years; 25 patients adopted traditional approach, 18 males and 7 females with the mean age of 40.1 years. The operative duration, blood loss and changes of postoperative serum level of Creatinine Kinase were com-pared. Total 47 patients were followed up with VAS scores 1 day preoperatively, 1 and 6 months postopera-tively. And EMG were adopted for long-term evaluation. Results There was no obvious difference in surgi-cal time, but less blood loss, lower index of serum level of Creatinine Kinase in Wihse paraspinal approach group. The VAS score in Wihse paraspinal approach was significantlt less than that in conventional approach group 1 and 6 months postoperatively. And in conventional approach group EMGs demonstrated fibrillation potentials, but they were normal in Wihse approach group. Conclusion The Wihse paraspinal approach is an easy way for treating of thoracolumbar vertebral fracture, minimize the soft tissue injury in operation and creates less complications after operation.