两种手术入路治疗胸腰椎骨折的近期疗效比较

目的对比分析经椎旁肌间隙入路与传统手术入路治疗胸腰椎骨折的近期疗效。方法回顾性分析2008年9月～2012年3月手术治疗的79例胸腰椎骨折患者，经传统手术入路48例，经椎旁肌间隙入路31例。纳入标准：TLICS评分均／〉4分，均无需椎管减压。分别统计两组的手术时间、术中出血量、术后引流量、切口长度、手术前后疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODD，测量两组手术前后的各放射学参数并进行对比分析，包括伤椎前、后缘高度／伤椎上下椎体前、后缘高度的均值，伤椎Cobb角的改善情况。结果患者随访3～28个月，平均13个月。经椎旁肌间隙入路较传统正中入路比较在手术时间、术中出血量、术后引流量、切口长度、术后3月VAS评分、术后1周及3个月ODI评分具有优势；而在感染率、术后2天VAS评分、骨折复位、脊髓恢复方面无统计学意义。结论传统手术入路相比，经椎旁肌间隙入路治疗胸腰椎骨折具有出血少、时间短、恢复快等优点，在骨折复位、脊髓恢复及感染率与传统手术入路相当。

Comparison of the short-term efficacy of two surgical approaches in the treatment of thoracic and lumbar spine fractures

Objective To comparatively assess the short-term effects of paraspinal muscle approach versus traditional surgical approach in the treatment ofthoracic and lumbar spine fractures. Methods From September 2008 to March 2012, A retrospective analysis of 79 cases of patients with thoracolumbar fractures were performed, including 48 cases by the traditional surgical approach and the other 31 cases by paraspinal muscle approach. Inclusion criteria： TLICS scorer〉4 points and no spinal decompression. Some indicators such as surgical time, the amount of bleeding, postoperative drainage, duration ofrecumbence, pain visual analogue score, Oswestry disability index, and the pre and postoperative radiologic parameters were statistically analyzed. Results All the patients were followed up with 3 to 28 months, mean 13 months, compared to tranditional approach, the posterior paraspinal muscle approach has the following advantages inluding surgical time, the amount of bleeding, postoperative drainage, length of the incision, the VAS score of 3 month after operation as well as ODI score of I week and 3 month after operation. In addition, no significant differences were found in terms of infection rate, the VAS score of 2 day after operation, fractures and spinal cord recovery. Con- clusion Compared with the traditional surgical approach, paraspinal muscles gap approach has some advantages for treat- ment of thoracolumbar fractures including less bleeding, short operative time, fast recovery and so on. In addition, fractures and infection rates is quite equal in both surgical approach..