经椎旁肌间隙与微创经皮入路手术治疗胸腰椎骨折后的肌肉损伤、炎症反应及骨代谢评估  

Assessment of the muscle injury,inflammatory response and bone metabolism after paravertebral muscle space and minimally invasive percutaneous approach surgeries for thoracolumbar fracture

作　　者：张锦[1] 佘青[1] 王新虎[1] 

机构地区：[1]陕西省宝鸡市中心医院,陕西宝鸡721008

出　　处：《海南医学院学报》2017年第15期2082-2085,2089,共5页Journal of Hainan Medical University

基　　金：陕西省科学技术研究发展计划项目(2014K11-03-06-10)

摘　　要：目的:研究经椎旁肌间隙与微创经皮入路手术治疗胸腰椎骨折后的肌肉损伤、炎症反应及骨代谢情况。方法:选择在本院就诊的92例胸腰椎骨折患者,随机分为椎旁入路组和经皮微创组,接受不同入路下的椎弓根螺钉内固定。手术前及手术后1、3天时,采集血清并检测肌酶、炎症反应分子、骨代谢指标的含量。结果:两组患者手术后1、3天时血清中Myo、CK、LDH、TNF-α、MCP-1、HMGB-1、CRP、IL-1β、OC、OPG、PICP、PINP的含量均显著高于手术前,TRACP5b、RANKL、CTX、NTX的含量均显著低于手术前且椎旁入路组患者手术后1天、3天时血清中Myo、CK、LDH、TNF-α、MCP-1、HMGB-1、CRP、IL-1β、TRACP5b、RANKL、CTX、NTX的含量均显著低于经皮微创组,OC、OPG、PICP、PINP的含量均显著高于经皮微创组。结论:经椎旁肌间隙入路手术治疗胸腰椎骨折能够较微创经皮入路手术更为有效地减轻肌肉损伤及炎症反应,同时改善骨代谢。Objective： To study the muscle injury, inflammatory response and bone metabolism after paravertebral muscle space and minimally invasive percutaneous approach surgeries for thoraeolumbar fracture. Methods： A total of 92 patients with thoraeolumbar fractures who were treated in Baoji Central Hospital were selected, patients were randomly divided into pa- ravertebral group and minimally invasive pereutaneous group who underwent pedicle screw fixation under different approaches. Before operation as well as 1 d and 3 d after operation, serum was collected to determine the contents of creatinase, inflammatory reaction molecules and bone metabolism indexes. Results： Serum Myo, CK, LDH, TNF-α, MCP-1, HMGB-1, CRP, IL -1β, OC, OPG, PICP and PINP levels of both groups 1 d and 3 d after operation were significantly higher than those before op eration, while TRACP5b, RANKL, CTX and NTX levels were significantly lower than those before operation. Serum Myo, CK, LDH, TNF-α, MCP-1, HMGB-1, CRP, IL-1β, TRACPSb, RANKL, CTX and NTX levels of paravertebral group 1 d and 3 d after operation were significantly lower than those of minimally invasive percutaneous group, while OC, OPG, PICP and PINP levels were significantly higher than those of minimally invasive percutaneous group. Conclusion： Paravertebral mus- cle space surgery for thoraeolumbar fracture is more effective than minimally invasive pereutaneous surgery in reducing muscle injury and inflammatory response, and improving bone metabolism.

关 键 词：胸腰椎骨折 经椎旁肌间隙入路 微创经皮入路 炎症反应 骨代谢 

分 类 号：R683.2[医药卫生—骨科学]