椎旁肌间隙入路椎弓根螺钉内固定治疗胸腰段脊柱骨折的临床效果  

Effect of paraspinal sacrospinalis-splitting approach for the treatment of thoracolumbar fractures

作　　者：柳海铭 张沿洲 张圣兵[1] 胡牮[1] 刘政[1] 王根林[2] 

机构地区：[1]江苏省昆山市第四人民医院骨科,江苏昆山215331 [2]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《中国医药导报》2016年第24期81-84,共4页China Medical Herald

基　　金：国家自然科学基金资助项目(81271960)

摘　　要：目的探讨椎旁肌间隙入路椎弓根螺钉内固定治疗胸腰段脊柱骨折的临床效果。方法选择2007年7月-2015年6月江苏省昆山市第四人民医院和苏州大学附属第一医院收治的49例胸腰段脊柱骨折患者为研究对象，根据手术入路方式的不同将其分为观察组（25例）和对照组（24例）。观察组采用Wiltse肌间隙入路联合伤椎置钉短节段固定治疗，对照组采用传统剥离椎旁肌后入路伤椎置钉短节段固定治疗。比较两组患者的手术时间、手术出血量、术后下地时间；观察两组患者术前及术后1d、1周、2周、6个月时腰背部疼痛情况；观察两组患者手术前、术后下地前和末次随访时X线片上椎体高度；记录两组患者手术并发症及内固定松动、断裂情况。结果观察组手术时间、手术出血量、术后下地时间均少于对照组，差异均有统计学意义（P〈0．05）。两组术后不同时点VAS评分均低于术前，差异均有统计学意义（P〈0．05）；两组术后不同时点VAS评分比较，差异均有统计学意义（P〈0．05）。两组患者术后下地前及末次随访时伤椎前缘高度比值均较术前明显改善，差异均有统计学意义（P〈0．05）；两组术前、术后下地前及末次随访时伤椎前缘高度比值比较，差异均元统计学意义（P〉0．05）。结论椎旁肌肌间隙入路治疗胸腰段骨折具有手术时间短，术中出血量少、创伤小、术后恢复快，疗效确切等优点。Objective To explore the clinic effect of paraspinal sacrospinalis-splitting approach for the treatment of thoracolumbar fractures. Methods A total of 49 patients with thoracolumbar fractures were included from July 2007 to June 2015 in Kunshan Fourth People's Hospital and the First Affiliated Hospital of Soochow University were selected as the study objects,and were assigned to observation group(n = 25) and control group(n = 24) according to the different methods of surgical approach. Sacrospinalis-splitting approach plus vertebral nailing fixation was used in patients of the observation group, vertebral muscle posterior approach plus vertebral nailing fixation was used in patients of the control group. Operation time, the amount of operative bleeding, ambullation time after operation of two groups were compared; pain of waist and back of two groups before operation and 1 d, 1 week, 2 weeks, 6 months after operation were observed; vertebral body height of patients in two groups before operation, down before postoperation and at the time of the last follow-up on the X ray film; surgical complications and the status of internal fixation loosening and fracture of patients in the two groups were observed. Results Operation time, the amount of operative bleeding, ambullation time of the observation group after operation were less than those of the control group, the differences were statistically significant(P < 0.05); VAS scores at different time point of the two groups after operation were lower than those before operation, the differences were statistically significant(P < 0.05); VAS scores at different time point of the two groups after operation were lower than those before operation, the differences were statistically significant(P < 0.05);VAS scores at different time point between the two groups had statistically significant differences(P < 0.05). The vertebral body height in two groups down before postoperation and at the time of the last follow-up was significantly improved compared with before operation, th

关 键 词：椎旁肌间隙入路 胸腰椎骨折 内固定 

分 类 号：R683.2[医药卫生—骨科学]