微创入路伤椎椎弓根螺钉撬拨复位内固定治疗胸腰椎骨折的临床研究  

Clinical Research of Vertebral Pedicle Screw Poking Reduction and Internal Fixation via Minimally Invasive Approach for the Treatment of Thoracolumbar Fractures

作　　者：鞠亮[1] 陈波[1] 

机构地区：[1]山东省临沂市沂水中心医院,山东沂水276400

出　　处：《中国医学创新》2015年第29期130-133,共4页Medical Innovation of China

基　　金：山东省临沂市科技发展计划项目(201515034)

摘　　要：目的：探讨胸腰段椎体骨折后路复位内固定脊柱稳定结构的保护措施及临床疗效。方法：选取2010年1月-2013年1月经伤椎椎弓根螺钉撬拨复位内固定治疗胸腰椎骨折的43例患者,按照随机数字表法将其分为椎旁肌间隙入路组（肌间隙组）23例和传统后正中入路组（传统组）20例。比较两组患者的手术时间、术中出血量、术后引流量、术后腰部疼痛情况（VAS）及影像学指标。结果：两组患者术后随访12-18个月,肌间隙组的手术时间明显短于传统组,术中出血量和术后引流量均明显少于传统组,比较差异均有统计学意义（P〈0.05）。两组术前平均VAS评分比较差异无统计学意义（P〉0.05）,肌间隙组术后3 d和末次随访的VAS评分均明显低于传统组,差异均有统计学意义（P〈0.05）。至末次随访,两组患者的骨折椎体高度均无丢失、无内固定物断裂,伤椎的高度恢复两组均满意。结论：经椎旁肌间隙入路对椎旁肌影响小,并发症少,有利于保护脊柱的稳定结构,与经伤椎椎弓根螺钉撬拨复位内固定起协同作用,能够获得良好的治疗效果。Objective：To investigate the protection measures and clinical effects of spine stabilizing system of posterior reduction and internal fixation for the treatment of thoracolumbar fractures.Method：43 patients with thoracolumbar fractures who were treated with vertebral pedicle screw poking reduction and internal fixation admitted to our hospital from January 2010 to January 2013 were selected as research objects.They were divided into the modified paraspinal approach group（paraspinal approach group） for 23 cases and the traditional posterior median approach group（conventional approach group） for 20 cases according to the random number table method.The operative time,intraoperative blood loss,postoperative drainage volume,postoperative lumbar pain（VAS）and radiographic indexes between the two groups were compared.Result：Patients of the two groups were followed up for 12-18 months,The operative time of the paraspinal approach group was significantly shorter than the conventional approach group,the intraoperative blood loss and postoperative drainage volume of the paraspinal approach group were significantly less than the conventional approach group,the differences were statistically significant（P〈0.05）.There was no statistically significant difference in the average VAS score before surgery（P〉0.05）.The average VAS score of paraspinal approach group 3 days after surgery and the last follow-up were significantly lower than the conventional approach group,the differences were statistically significant（P〈0.05）.Up to the last follow-up,the fracture vertebral height of two groups were no loss,no fracture internal fixation,vertebral height restoration in two groups were satisfied.Conclusion：The influence of modified paraspinal approach for the thoracolumbar spinal fracture to the paraspinal muscle is small,less complications,is conducive to the protection of spine stabilizing system,and there are synergistic effects with transpedicular screw fixation,can obtain good therapeutic effect.

关 键 词：胸腰椎骨折 骨折固定术 椎旁肌间隙入路 终板复位 

分 类 号：R687.3[医药卫生—骨科学]