| 毛仲轩,孔兰新,张善地.多段小切口椎旁肌间隙入路治疗胸腰段椎体压缩性骨折.骨科,2015,6(2): 83-87. |
| 多段小切口椎旁肌间隙入路治疗胸腰段椎体压缩性骨折 |
| Application of paraspinal muscle space approach with multi-segment small incision in treatment of thoracolumbar compression fracture of vertabral body |
| 投稿时间：2014-12-17 |
| DOI：10.3969/j.issn.1674-8573.2015.02.007 |
| 中文关键词: 胸椎 腰椎 骨折 多裂肌 切口 |
| 英文关键词: Thoracic vertebae Lumbar vertebae Fractures, bone Multifidus muscles Incisal opening |
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| 中文摘要: |
| 目的 对比研究多段小切口椎旁肌间隙入路和传统后正中入路治疗胸腰段椎体压缩性骨折的疗效。方法 回顾性分析我科于2013年6月至2014年8月手术治疗外伤所致48例胸腰段椎体压缩性骨折病例，其中21例采用传统后正中入路治疗（后正中入路组），另外27例采用多段小切口椎旁肌间隙入路治疗（椎旁肌间隙入路组）。记录两组手术时间、术中出血量、术后引流量；分别于术前及术后1、3和5 d检测两组患者血清肌酸激酶值；术前和术后3 d常规拍摄X线片，比较两组Cobb角矫正率；应用视觉疼痛模拟评分（visual analogue scale，VAS）评估患者术前和术后疼痛情况。结果 所有患者经治疗后临床症状明显缓解，功能恢复较好。两组术前指标差异无统计学意义。椎旁肌间隙入路组手术时间、术中出血量、术后引流量均少于后正中入路组（P<0.01）；VAS评分术后两组均较术前明显改善，椎旁肌间隙入路组优于后正中入路组（P<0.01）；血清肌酸激酶值术后两组均有不同程度升高，并逐渐降低，椎旁肌间隙入路组较后正中入路组下降快（P<0.01）；Cobb 角术后两组均较术前明显好转（P<0.01）。结论 对于部分类型胸腰段骨折，多段小切口椎旁肌间隙入路可以作为一种手术入路选择，疗效明显，但需要严格掌握手术适应证。 |
| 英文摘要: |
| Objective To investigate the paraspinal muscle space approach with multi-segment small incision vs. conventional posterior midline approach in the treatment of thoracolumbar compression fracture of vertabral body. Methods From Jun. 2013 to Aug. 2014, a total of 48 patients with traumatic thoracolumbar fracture were treatmented surgically. Twenty-one cases were subjected to conventional posterior midline approach (conventional posterior midline approach group), and the rest was subjected to paraspinal muscle space approach with multi-segment small incision (paraspinal muscle space approach group). The amount of intraoperative bleeding and postoperative bleeding, and operative time were compared between two groups. The serum creatine kinase levels were determined preoperatively and on the postoperative day 1, 3, and 5. Cobb angle correction rate was compared byt the preoperative and postoperative X ray examination between the two groups. The visual pain analog score (VAS) was assessed in patients with preoperative and postoperative pain. Results The clinical symptoms of all patients were relieved after treatments. All patients get better functional recovery. The preoperative indicators did not show significant difference between two groups. The amount of intraoperative bleeding and postoperative bleeding was significantly less, and operative time was shorter in paraspinal muscle space approach group than in conventional posterior midline approach group (P<0.01). There was significant difference in VAS score in the two groups before and after operation (P<0.01), and VAS score in paraspinal muscle space approach group was higher than in conventional posterior midline approach group (P<0.01). Postoperative serum creatine kinase levels in two groups were increased to varying degrees, then gradually reduced, and rapidly declined in paraspinal muscle space approach groupas compared with conventional posterior midline approach group. Cobb angle of postoperative patients in both two groups were improved significantly (P<0.01). Conclusion For some types of thoracolumbar fractures, the paraspinal muscle space approach with multi-segment small incision can be used as a surgical approach option, with significant effect, but it needs to hold the surgical indications strictly. |
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