经椎旁肌间隙入路治疗胸腰椎骨折  

Surgical treatment of thoracolumbar fractures through the Wiltse approach

作　　者：彭茂秀[1] 汤呈宣[1] 林利兴[1] 戴鸣海[1] 唐小君[1] 何少奇[1] 杨国敬[1] 

机构地区：[1]温州医学院附属第三医院脊柱外科,浙江瑞安325200

出　　处：《临床骨科杂志》2013年第2期129-131,共3页Journal of Clinical Orthopaedics

基　　金：温州市科技局科技计划项目(编号:Y20110184);瑞安市科技计划项目(编号:201102044)

摘　　要：目的探讨经椎旁肌间隙行后路椎弓根螺钉内固定术治疗胸腰椎骨折的临床疗效。方法选择66例后路椎弓根螺棒系统撑开复位内固定治疗的胸腰椎骨折患者,按治疗方法分为2组,34例采用经椎旁肌间隙入路(A组),32例行传统手术入路(B组)。结果 66例随访时间均>1年。手术时间:A组为72 min±12min,B组为76 min±15 min(P>0.05)。术中出血量:A组为80 ml±24ml,B组为120 ml±30 ml(P<0.01)。术后引流量:A组为70 ml±35 ml,B组为150 ml±55 ml(P<0.01)。外周血肌酸激酶:两组术前及术后1周差异无统计学意义(P>0.05);术后24 h及48 h两组差异均有统计学意义(P<0.01)。椎体前缘高度、后凸Cobb角:两组术后较术前均有明显的恢复(P<0.01),两组间差异无统计学意义(P>0.05)。结论经椎旁肌间隙入路治疗胸腰椎骨折具有创伤小、出血少、恢复快等优点,是治疗单节段胸腰椎骨折的有效方法。Objective To investigate the clinical outcome of tile surgical treatment of thoracolumlsar fractures lhrough the Wihse paraspinal approach. Methods 66 patients were treated with posterior pedicle screw and rod system by distraction reduction and internal fixation of thoraeolumbar fracture patients. According to the treatmenl, all cases were divided into two groups, A group of 34 patients through the Wihse paraspinal approach and B group of 32 cases through traditional surgieal appruach. Results 66 patients were followed up more than I year. A group of operative time of 72 min±12 rain, in group B fur 76 min±15 rain （P〉0.05）. A group of blood loss of 80 ml±24 ml, B group 120 ml±30 ml （P〈0. 01）. The postoperative drainage A 70 ml±35 ml, B group 150 ml ±55 ml （P〈 0. 01 ）. Two groups of peripheral I）luod ereatine kinase before and after one week was no significant difference（P 〉 0. 05 ） ; but 24 h and 48 h were significant differences after surgery （ P 〈0.01 ）. Postoperative compared with preoperative anterior vertebral height, kyphotic Cobb angle showed significant response （ P 〈 0. 01 ） , no statistically significant difference between the two groups （P 〉 0. 05 ）. Conclusions The Wiltse paraspinal approach to treat thoracolumbar fractures with less trauma,less bleeding, quick recovery and other advantages, is an effective method fnr the treatment of single segmental thoracolumbar fractures.

关 键 词：椎旁肌间隙入路 胸腰椎 脊柱骨折 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]