经椎旁肌间隙入路治疗胸腰椎骨折的临床意义

目的探讨胸腰椎骨折切开复位内固定术中经椎旁肌间隙入路的临床疗效,并与传统后正中入路疗效进行比较。方法将78例切开复位内固定治疗的胸腰椎（T11～L2）骨折患者随机分为观察组和对照组,观察组与对照组分别经椎旁肌间隙入路与后正中入路,比较2组患者围手术期指标如手术时间、术中出血量等,影像学指标及随访期间腰背痛VAS评分、磁共振多裂肌面积等。结果术中出血量、术后引流量及住院日在观察组明显少于对照组,差异有统计学意义（P〈0.05）;观察组术后腰背痛VAS评分方面明显优于对照组（P〈0.05）,而术前术后2组患者在Cobb角、椎体高度、椎间隙高度等方面差异无统计学意义（P〉0.05）;观察组患者术前与术后多裂肌MRI横断位面积差异无统计学意义（P〉0.05）,而对照组术后较术前明显减少（P〈0.05）。结论经椎旁肌间隙入路治疗胸腰椎骨折可避免广泛剥离椎旁肌,进而保护了椎旁肌,减轻了术后腰背痛程度。

Surgical treatment of thoracolumbar fractures via paraspinal intermuscular approach

Objective To study the clinical effects of open reduction and internal fixation of thoracolumbar fractures via paraspinal intermuscular approach,and compare to the conventional midline approach. Methods 78 patients with thoracolumbar（T11- L2） fractures were randomly divided into observation group（via paraspinal intermuscular approach） and control group（midline approach）,and received the open reduction and internal fixation. The operative time,perioperative blood loss,imaging indicators,backache VAS score,MRI multifidus area and other indicators were compared. Results The observation group was significantly better than the control group in blood loss,postoperative drainage and hospitalization（P〈0. 05）;the backache VAS score in the observation group were significantly better than the control group after surgery（P〈0. 05）,whereas there were no significant difference in Cobb angle,vertebral height,disc height in the two groups before and after surgery（ P〉 0. 05）;there were no significant difference of MRI multifidus area in observation group after surgery（P〉 0. 05）,but that in control group was significantly reduced compared with the preoperative（ P〈0. 05）. Conclusion The paraspinal intermuscular approach is of little paraspinal muscle injury in the treatment of thoracolumbar fractures. It can protect the paraspinal muscles and improve the degree of postoperative backache.