多裂肌间隙入路与经皮入路联合伤椎置钉治疗无神经损伤的胸腰段椎体骨折的对比研究  

Combination of transpedicle screw fixation and lordorizing screw fixation via percutaneous Wiltse paraspinal approach for the treatment of thoracolumbar spine fracture without nerve injury

作　　者：翁献 王根林[1] 章戈[1] 张亚中 郑培炎 姜为民[1] 杨惠林[1] Weng Xian;Wang Genlin;Zhang Ge;Zhang Yazhong;Zheng Peiyan;Jiang Weimin;Yang Huilin(Department of Orthopaedics,the First Affiliated Hospital,Soochow University,Suzhou 215000,China;Department of Orthopaedics,Changshu Fifth People's Hospital,Changshu 215500,China)

机构地区：[1]苏州大学附属第一医院骨科,苏州215000 [2]浙江省常熟市第五人民医院骨科,215500

出　　处：《中华解剖与临床杂志》2020年第6期662-667,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨多裂肌间隙入路和经皮入路分别联合伤椎置钉治疗无神经损伤胸腰段椎体骨折的临床疗效。方法回顾性分析苏州大学附属第一医院2015年1月—2018年1月采用多裂肌间隙入路和经皮入路分别联合伤椎置钉治疗无神经损伤的胸腰段椎体骨折的52例患者的临床资料。经多裂肌间隙入路患者25例(A组),男19例、女6例,年龄35~67 (49.84±9.11)岁;经皮入路患者27例(B组),男20例、女7例,年龄21~66(48.44±11.02)岁。比较两组患者一般资料,以及手术出血量、手术时间、术后镇痛药物使用率、术后下地时间及术后住院时间;手术前后不同时间点的腰背部疼痛视觉模拟评分(VAS);比较两组手术前、术后下地前及术后12个月时伤椎前缘高度比值和矢状位Cobb角变化。结果两组患者一般资料比较差异均无统计学意义(P值均>0.05)。均顺利完成手术,术后随访12个月。A组的手术时间、术后下地时间分别为120(90,136)min、2(1,3)d,均短于B组的144(110,220)min、4(2,5)d,差异均有统计学意义(P值均<0.05);A组术后使用镇痛药物例数(2例)少于B组(15例),差异有统计学意义(P<0.05);两组患者手术出血量、术后住院时间差异均无统计学意义(P值均>0.05)。两组患者术后VAS评分均较术前有明显改善,差异均有统计学意义(P值均<0.01);A、B组间术前、术后12个月VAS评分比较,差异均无统计学意义(P值均>0.05),但术后第3天VAS评分比较,A组低于B组,差异有统计学意义(P<0.05)。两组患者术后下地前及术后12个月伤椎前缘高度比值、矢状面Cobb角较术前改善明显,差异均有统计学意义(P值均<0.05),但两组间同时间点伤椎前缘高度比值和矢状面Cobb角比较差异均无统计学意义(P值均>0.05)。结论多裂肌间隙入路和经皮入路分别联合伤椎置钉治疗无神经损伤的胸腰段椎体骨折均取得良好疗效,在改善骨折畸形及远期腰背部疼痛上无明显差异,但�Objective To investigate the effectiveness of percutaneous and multi-fissure intermuscular approach combined with injured vertebral screw fixation for the treatment of thoracolumbar fracture without nerve injury.Methods Retrospective analysis was conducted on the data of 52 patients with thoracolumbar fracture who were treated with percutaneous approach and multi-fissure intervertebral approach in the First Affiliated Hospital of Soochow University from January 2015 to January 2018.The patients were categorized in group A,which consisted of 25 individuals including 19 males and 6 females aged 35-67(49.84±9.11)years who received the multi-fissure intervertebral approach,and group B,which comprised 27 individuals including 20 males and 7 females aged 21-66(48.44±11.02)years who received the percutaneous approach.General data including bleeding volume,operation time,postoperative use of analgesic drug,postoperative grounding time and hospital stay,and visual analog score(VAS)of low back pain were obtained at different time points before and after surgery.Anterior height of vertebra and Cobb angle were compared before and 12 months after surgery.Results Both groups successfully completed the operation and were followed up for 12 months.No significant difference on general data was observed between the two groups(all P values>0.05).The operative time and postoperative grounding time in group A were shorter than those in group B[120(90,136)min vs.144(110,220)min,2(1,3)days vs.4(2,5)days,respectively],and the difference was statistically significant(all P values<0.05).The number of patients using analgesic drug in group B was higher than that in group A(15 vs.2),and the difference was statistically significant(P<0.05).No significant difference in the amount of surgical bleeding and length of postoperative hospitalization was found between the two groups(all P values>0.05).The VAS scores of both groups were significantly improved after operation compared with those before operation,and the difference was statistically

关 键 词：脊柱骨折 胸椎 腰椎 骨折固定术 经皮入路 多裂肌间隙入路 

分 类 号：R687.3[医药卫生—骨科学]