经椎旁肌间隙入路治疗胸腰段椎体骨折  

Surgical Treatment of Thoracolumbar Fractures through the Approach between Para-vertebral Muscle

作　　者：周景和[1] 徐良丰[1] 邹平[1] 徐华梓[1] 

机构地区：[1]温州医学院附属第二医院脊柱外科,浙江温州325000

出　　处：《实用骨科杂志》2011年第4期298-300,共3页Journal of Practical Orthopaedics

摘　　要：目的探讨经椎旁肌间隙入路复位内固定术治疗胸腰段椎体骨折的治疗效果。方法 2006年6月至2009年12月,采用后路切开复位内固定术治疗无神经损伤表现的胸腰段椎体骨折患者45例。随机采用经椎旁肌间隙入路23例,男15例,女8例;年龄18～65岁,平均40.4岁。传统后正中入路22例,男16例,女6例;年龄21～59岁,平均41.5岁。比较两组患者围手术期参数及影像学指标。结果通过围手术期疗效观察,发现经椎旁肌间隙入路手术与传统后正中手术相比较在手术时间上差异不大,在伤椎Cobb角的矫正度上差异亦无统计学意义,但在出血量、术后引流量、卧床时间、住院天数以及术后疼痛视觉模拟评分(visual analogue scale,VAS)等方面都具有显著的优势,差异有统计学意义(P<0.05)。所有患者均获得随访,平均随访时间20个月(12～26个月),所有随访患者的骨折椎体均获得愈合,无一例发生骨折复位丢失及内固定物的松动、断裂,两组间远期疗效无差异。结论经椎旁肌间隙入路内固定治疗胸腰段椎体骨折具有创伤小、出血少、术者操作简单、术后患者恢复快等优点。Objective To investigate the results of the operative treatment of thoracolumbar fractures through the approach between the para-vertebral muscle.Methods From June 2006 to December 2009,a total of 45 patients,who suffered from thoracolumbar vertebral fractures with neurological intact,underwent posterior open reduction and internal fixation.Randomly,23 patients adopted the above approach,including 15 males and 8 females with the mean age of 40.4 years;22 patients adopted traditional approach,l 6 males and 6 females with the mean age of 41.5 years.To compare the two groups′ parameter of perioperative period and intervertebral indicators.Results Through comparison between the above two groups earlier post-operatively,the results confirmed that the approach had obvious advantage over traditional method in blood loss,drainage,duration of recumbence,length of stay and visual analogue scale（VAS）,and the difference was of statistical significance（P0.05）,although the time-consuming and the the correction of Cobb′s angle was almost the same between the two approaches.All patients were available and all got bone union on final follow-up with duration from 12 to 26 months（mean,20months）.Neither reduction loss nor loosening or breakage of the fixator had occurred in two groups.Conclusion This technique of operative treatment through the approach between the para-vertebral muscle is much less invasive and applicable for the thoracolumbar fractures,which can reduce the blood loss,accelerate the rehabilitation simultaneously.

关 键 词：脊柱骨折 微创性 治疗 

分 类 号：R683.2[医药卫生—骨科学]