经皮多裂肌间隙入路与传统开放术式在治疗胸腰椎骨折中对椎旁肌损伤的对比研究  

A Comparative Study of the Paraspinal Muscle Function in the Treatment of Thoracolumbar Fractures by Percutaneous Multifidus Muscle Space Approach and Traditional Approach

作　　者：贺旭[1] 马雪峰[1] 刘恺[1] 赵廷虎[1] 

机构地区：[1]深圳平乐骨伤科医院坪山院区脊柱科,广东深圳518122

出　　处：《中外医疗》2016年第30期11-13,16,共4页China & Foreign Medical Treatment

基　　金：广东省医学科研基金(A2013625)

摘　　要：目的比较经皮多裂肌间隙入路与传统开放术式在治疗胸腰椎骨折中对椎旁肌损伤的影响。方法方便选择自2013年1月—2014年12月无神经损伤的胸腰段脊柱骨折患者60例,随机分为两组,30例采用经皮多裂肌间隙入路椎弓根螺钉内固定术(实验组),30例采用传统后正中入路切开复位椎弓根螺钉内固定术(对照组)。观察两组的患者手术时间、术中出血量、术后引流量。比较两组患者术后第1、3天生化全套测量肌酸磷酸激酶含量,比较两组术后1个月VAS评分和ODI评分,以及矢状面Cobb角和椎体压缩率。结果所有患者均顺利完成手术,实验组的其手术时间(52.6±6.1)min、术中出血(73.9±16.7)m L、术后引流量(27.3±5.2)m L明显少于对照组,差异有统计学意义(P<0.05);实验组术后第1、3天生化全套测量肌酸磷酸激酶(CK)(263.8±4.0)U/L,(162.6±2.9)U/L明显低于对照组,差异有统计学意义(P<0.05);两组术后1个月VAS评分(2.0±0.7)分、ODI评分(24.7±3.9)分,差异有统计学意义(P<0.05);术后Cobb角实验组改善(20.2±3.0)°,对照组改善(19.3±1.7)°,椎体复位实验组(42.2±2.8)%,对照组(42.1±3.5)%,差异无统计学意义(P>0.05)。结论经皮多裂肌间隙入路与传统后入路术后早期相比,具有出血少、对椎旁肌影响小、疼痛缓解快,利于胸腰椎骨折患者康复。Objective To compare the effects of the percutaneous multifidus muscle space approach and traditional approach in the treatment of thoracolumbar vertebrae fracture. Methods Convenient between January 2013 and December2014,60 patients who suffering from thoracolumbar fractures without neurological deficit were randomly divided into two groups, 30 cases were operated through the percutaneous multifidus muscle space approach（experimental group）, while group of 30 cases were received conventional posterior median inlet surgery（control group）. Compare clinical indicators such as operation time, intraoperative blood loss, CK, preoperative and postoperative Cobb angle, vertebral compression ratio,VAS and ODI score. Results All patients were successfully completed surgery, The differences between surgical operation time（52.6±6.1）min, the blood loss（73.9±16.7）m L, postoperative drainage（27.3±5.2）m L, CK of postoperative in 1 and 3days（263.8±4.0） U/L,（162.6±2.9） U/L, Significantly lower than the control group, the difference was statistically significant（P〈0.05）; the two groups of postoperative January VAS score（2±0.7）, ODI score（24.7 ± 3.9）, the difference was statistically significant（P〈0.05）; postoperative Cobb angle improved experimental group（20.2 ± 3）°, control group（19.3 ± 1.7）°, vertebral body of experimental group（42.2 ± 2.8）%, control group（42.1±3.5）%, there was no statistically significant difference（P〉0.05）. Conclusion Compared with the traditional approach, the Wiltse paraspinal approach has less bleeding, minimal trauma, fast recovery and good result.which is beneficial to the patients with thoracolumbar fracture.

关 键 词：椎旁肌 胸腰椎骨折 肌间隙入路 后正中入路 早期疗效 

分 类 号：R687[医药卫生—骨科学]