小切口椎旁肌间隙入路治疗胸腰椎骨折的围术期及近期疗效分析  

Perioperative and short-term advantages of minimally invasive approach for the treatment of thoracolumbar fracture

作　　者：王诗军[1] 李淳德[1] 刘宪义[1] 孙浩林[1] 于峥嵘[1] 邑晓东[1] 李宏[1] 刘洪[1] WANG Shi-jun LI Chun-de LIU Xian-yi SUN Hao-lin YU Zheng-rong YI Xiao-dong LI Hong LIU Hong(Department of Orthopedics, Peking University first Hospital, Beijing, 100034, China)

机构地区：[1]北京大学第一医院骨科,100034

出　　处：《中国骨与关节杂志》2017年第10期742-746,共5页Chinese Journal of Bone and Joint

摘　　要：目的观察小切口椎旁肌间隙入路短节段固定结合伤椎置钉治疗胸腰椎骨折的围术期及近期疗效。方法回顾性分析2013年1月至2016年7月,我院收治的46例胸腰段椎体骨折患者,其中采用椎旁小切口肌间隙入路治疗24例(椎旁小切口组),传统正中入路治疗22例(传统手术组)。比较两组手术时间、术中出血量、术后住院时间,末次随访时采用Oswestry功能障碍指数(oswestry disability index,ODI)评估临床疗效。结果两组患者年龄、性别、身高、体重、体质量指数、术前疼痛视觉模拟评分、术前ODI比较,差异均无统计学意义(P>0.05),具有可比性。椎旁小切口组平均手术时间(114.5±26.3)min,传统手术组平均手术时间(105.7±23.4)min,差异无统计学意义(P>0.05)。椎旁小切口组平均术中出血量(118.6±32.1)ml,传统手术组平均术中出血量(217.4±41.5)ml,差异有统计学意义(P<0.05)。椎旁小切口组平均术后住院时间(3.8±1.1)天,传统手术组平均术后住院时间(5.4±1.4)天,差异有统计学意义(P<0.05)。末次随访时ODI椎旁小切口组为(15.9±11.4),传统手术组为(30.1±15.2),差异有统计学意义(P<0.05)。结论减少肌肉损伤的小切口椎旁肌间隙入路治疗胸腰椎骨折具有创伤小、术后恢复快的优点,但远期疗效需要进一步观察。Objective To investigate the perioperative and short-term clinical outcomes of minimally invasive approach for the treatment of thoracolumbar fracture（ minimally invasive paraspinal muscle approach ＋ pedicle screw fixation）. Methods From January 2013 to July 2016, 46 patients with thoracolumbar fracture were retrospectively analyzed. Twenty-four patients underwent surgeries by minimally invasive paraspinal muscle approach（ minimally invasive group）, and 22 patients by conventional median approach（ conventional group）. Operation time, intraoperative blood loss, postoperative hospitalization stay were compared between 2 groups. Clinical results were assessed by Oswestry disability index（ ODI） in the final follow-up. Results There were no significant differences in age, gender, height, weight, body mass index, preoperative visual analogue scale, and preoperative Oswestry disability index（ ODI） between the 2 groups（ P〉0.05）. There were no significant differences in the mean operation time between the 2 groups： minimally invasive group（ 114.5 ± 26.3） min, conventional group（ 105.7 ± 23.4） min（ P〉0.05）. There were significant differences in the intraoperative blood loss： minimally invasive group（ 118.6 ± 32.1） ml, conventional group（ 217.4 ± 41.5） ml（ P〈0.05）. There were significant differences in the hospitalization stay： minimally invasive group（ 3.8 ± 1.1） days, conventional group（ 5.4 ± 1.4） days（ P〈0.05）. There were significant differences in the ODI in the final follow-up： minimally invasive group（ 15.9 ± 11.4）, conventional group（ 30.1 ± 15.2）（ P〈0.05）. Conclusions Minimally invasive paraspinal muscle approach has the advantages of being less invasive and quick recovery, but further investigations are still needed to confirm the long term effects.

关 键 词：脊柱骨折 胸椎 腰椎 最小侵入性外科手术 

分 类 号：R687.3[医药卫生—骨科学]