改良多裂肌间隙与传统后正中入路椎弓根螺钉置入修复胸腰椎骨折:伤椎稳定性及相关指标比较  

Modified transmultifidus approach and posterior central approach of vertebrae pedicle screws in the treatment of thoracolumbar vertebral fractures: vertebral stability and related indexes

作　　者：胡正霞[1] 李开南[1] 何智勇[1] 

机构地区：[1]成都大学附属医院骨科,四川省成都市610081

出　　处：《中国组织工程研究》2015年第4期543-547,共5页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(81171753)~~

摘　　要：背景:由于经后正中入路常规治疗胸腰椎骨折创伤较大,Wiltse等于1968年提出经多裂肌和最长肌间隙的入路用于胸腰椎骨折的椎弓根置钉方法,后因存在暴露不够充分、手术难度较高未能广泛采用,但目前外科医生越来越重视如何减少手术创伤而能够达到更好的修复效果。目的:探索改良多裂肌间隙入路行椎弓根螺钉置入内固定修复无神经损伤胸腰椎压缩性骨折,认识其手术适应证和优势。方法:回顾性分析30例于2011年9月至2013年9月在成都大学附属医院行无神经损伤胸腰椎压缩性骨折手术的患者,分为对照组和实验组,分别接受常规后正中入路和改良多裂肌间隙入路椎弓根螺钉内固定治疗。结果与结论:改良肌间隙入路修复无神经损伤胸腰椎压缩性骨折修复较传统后正中入路可以明显缩短置钉时间,缩短手术时间,减少术中出血量,术后患者目测类比评分明显优于传统后正中入路组;修复后2组无神经损伤胸腰椎压缩性骨折患者伤椎前缘高度恢复及Cobb角的改变差异无显著性意义。提示改良多裂肌间隙入路行椎弓根螺钉内固定修复无神经损伤胸腰椎压缩性骨折在置钉时间、手术时间、术中出血量方面与传统入路无区别,在有效减轻术后腰背部疼痛方面与常规后正中入路比较有明显优势。BACKGROUND：Traditional treatment of thoracolumbar fractures through posterior central approach may induce trauma. Wiltseet al have proposed the paraspinal approach of vertebrae pedicle screw in the treatment of thoracolumbar fractures. However, this treatment is restricted due to deficient exposure and high surgical technique. It’s widely concerned to reduce surgical trauma and achieve better restoration effect. OBJECTIVE：To analyze the surgical indications and advantages of vertebrae pedicle screws in the treatment of thoracolumbar fractures through the modified transmultifidus approach. METHODS：From September 2011 to September 2013, 30 patients with thoracolumbar fractures were treated with vertebrae pedicle screw in Chengdu University Affiliated Hospital. The involved patients were divided into two groups, receiving pedicle screw fixation through the normal approach and the improved paraspinal approach, respectively. RESULTS AND CONCLUSION：The improved paraspinal approach obviously shortened the screw placement time and the surgical time, reduced blood loss, and improved visual analogue scale scores, compared with traditional posterior central approach of vertebrae pedicle screws in the treatment of thoracolumbar fractures. There was no significant difference in the postoperative improvement of vertebral height and Cobb angles. The modified transmultifidus approach is better than posterior central approach in the improvement of postoperative＆nbsp;pain, but shows no difference in the screw placement time, surgical time and blood loss, in treatment of thoracolumbar fractures.

关 键 词：植入物 脊柱植入物 多裂肌间隙入路 椎弓根螺钉 内固定 胸腰椎 脊柱 骨折 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]