| 郑亚东,陆生林.改良椎旁肌间隙入路与传统后正中入路治疗胸腰椎骨折的疗效比较.骨科,2018,9(2): 90-95. |
| 改良椎旁肌间隙入路与传统后正中入路治疗胸腰椎骨折的疗效比较 |
| Comparison in clinical outcomes between modified paraspinal muscle space approach and conventional posterior midline approach for thoracolumbar fractures with spinal injury |
| 投稿时间：2017-05-19 |
| DOI：10.3969/j.issn.1674-8573.2018.02.002 |
| 中文关键词: 胸椎 腰椎 脊柱骨折 脊柱融合术 对比研究 |
| 英文关键词: Thoracic vertebrae Lumbar vertebrae Spinal fusion Comparative study |
| 基金项目:广西医科大学青年科学基金项目（GXMUYSF201637） |
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| 中文摘要: |
| 目的 比较改良椎旁肌间隙入路与传统后正中入路治疗胸腰椎骨折合并脊髓损伤病人的效果。方法 纳入我科2014年1月至2016年1月收治的胸腰椎骨折合并脊髓损伤的病人40例，按随机数字表法分为传统组（采用传统后正中入路手术）和改良组（采用改良的椎旁肌间隙入路手术），每组20例。传统组：男13例，女7例，平均年龄为（37.3±8.5）岁；改良组：男14例，女6例，平均年龄为（37.5±6.2）岁。两组病人一般资料比较，差异均无统计学意义（均P＞0.05）。记录两组病人手术时间、术中出血量、术后引流量。记录并分析术前、术后1周、术后6个月腰部疼痛视觉模拟量表（visual analogue scale, VAS）评分，术前、术后6个月的Frankel脊髓损伤分级，术前、术后即刻、术后6个月的伤椎Cobb角。结果 病人均获得7~20个月的随访，平均随访时间为14个月。两组病人在手术时间、伤椎Cobb角矫正、Frankel分级改善情况方面比较，差异均无统计学意义（均P＞0.05）。改良组的术中出血量为（150.0±35.8） ml，术后引流量为（82.5±14.5） ml，末次腰痛VAS评分为（1.6±0.5）分，均优于传统组的（269.5±39.9） ml、（151.3±19.2） ml、（2.5±0.5）分，差异均有统计学意义（均P＜0.05）。结论 椎旁肌间隙入路结合棘突旁有限显露治疗有脊髓损伤的胸腰椎骨折，在脊柱畸形矫正及神经功能恢复方面效果满意，且能减轻病人的手术创伤，术后病人腰背痛改善更明显。 |
| 英文摘要: |
| Objective To compare the clinical results between paraspinal approaches combined with limited paraspinous exposure and traditional posterior midline approach in treatment of thoracolumbar fractures with spinal injury. Methods Forty cases of thoracolumbar fractures with spinal injury (from January 2014 to January 2016) were prospectively analyzed, and randomly divided into two groups. Twenty cases were subjected to the posterior midline approach, and rest 20 cases were given paraspinal approach combined with limited paraspinous exposure. The duration of operation, intra-operative blood loss, post-operative drainage, changes of the VAS score of low back pain, Frankel scale of spinal injury, and vertebral Cobb angle were recorded. Results The paraspinal approach combined with limited paraspinous exposure group had a better performance in blood loss (150.0±35.8 vs. 269.5±39.9 ml) and post-operation drainage (82.5±14.5 vs. 151.3±19.2 ml), and postoperative VAS score (1.6±0.5 vs. 2.5±0.5) (all P＜0.05) than in the posterior midline approach group. There were no significant differences in operative time, anterior and posterior vertebral Cobb angle, and recovery of neurological function between the two groups (P＞0.05). Conclusion Paraspinal approach combined with limited paraspinous exposure in the treatment of thoracolumbar fractures with nerve injury has the same clinical efficacy as posterior midline approach. And it has the advantages of fewer traumas, and better relief of low back pain post-operation. |
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