经椎旁肌间隙入路短节段固定治疗胸腰椎骨折疗效分析

目的探讨椎旁肌间隙入路在胸腰椎骨折短节段内固定手术治疗中的临床疗效。方法对45例无需椎管减压的胸腰椎骨折患者行后路短节段内固定治疗，采用椎旁肌间隙入路20例（A组），传统后正中入路25例（B组），分别记录对两组手术时间、术中出血量、术后引流量、术前后疼痛感觉程度评分（VAS）、Cobb角矫正率、椎体塌陷矫正率指标，分析比较两组的手术效果。结果所有患者骨性愈合，无内固定物松动、断钉断棒；A组与B组的手术时间（88±17）min vs（105±14）min]、出血量（121±24）ml vs（230±31）m1]、术后引流量（66±28）ml vs（250±45）m1]差异有统计学意义（P〈0．05）；两组在伤椎Cobb角矫正率（82．3±1．58）％vs（83．5±3．71）％）]，椎体坍塌矫正率（88．22±3．18）％vs（87．19±2．16）％]，术后VAS评分等方面差异均无统计学意义（P〉0．05）。结论椎旁肌间隙入路内固定手术具有创伤小、入路简单、手术时间短、出血量少、术后恢复快等优点，它符合现代微创理念，是值得推广的一种手术入路。

Clinical efficacy analysis on the treatment of thoracolumbar fractures via paraspinal muscle gap approach

Objective To investigate the clinical efficacy of paraspinal muscle gap approach in the short segment internal fixation of thoracolumbar fractures. Methods Forty-five patients with thoracolumbar fractures but without spinal decompression underwent posterior short segment internal fixation, including 20 cases via paraspinal muscle gap approach（ group A）and 25 cases via traditional posterior midline approach. Operative time, intraoperatlve blood loss, postoperative drainage, visual analogue scale （VAS） score,correction rate of Cobb angle and correction rate of vertebral collapse were recorded and the surgical results were compared between the groups. Results All patients got bony union without internal fixation loosening,broken nails or broken rods. There were significant differences in operative time （88 ± 17 ） min vs（ 105 ±14 ） min ] , blood loss （ 121 ± 24 ） ml vs （ 230 ± 31 ） ml ] and postoperative drainage （66 ± 28 ）ml vs （250 ± 45 ）ml ] between group A and B respectively （P 〈 0.05 ）. The differences in correction rate of the Cobb angle （82.3 ± 1.58）% vs（83.5 ±3.71 ）% ] ,correction rate of the vertebral collapse （88.22 ± 3.18）% vs（87.19 ±2.16）% ] and postoperative VAS score were not significant between group A and B respectively （ P 〉 0.05 ）. Conclusion Internal fixation via paraspinal muscle gap approach has the advantages of less trauma, simple approach, short operative time, less blood loss, quick recovery after surgery. It is consistent with the modern concept of minimal invasion and worthy of spreading.