传统后正中入路椎旁肌间隙入路与微创经皮入路治疗胸腰椎骨折的炎症反应及骨代谢观察  

Observation of Inflammatory Response and Bone Metabolism in the Treatment of Thoracolumbar Fractures with Traditional Posterior Median Approach,Paraspinal Space Approach and Minimally Invasive Percutaneous Approach

作　　者：侯江业 张宁 蔡飞 杨振邦[1] 李耀章 董建彬 贺耀耀 HOU Jiangye;ZHANG Ning;CAI Fei(The First Orthopedic Ward, Yulin First Hospital, Shaanxi Yulin 719000, China)

机构地区：[1]陕西省榆林市第一医院骨科一病区,陕西榆林719000 [2]延安大学第二附属医院/榆林市第一医院绥德院区骨科一病区,陕西榆林718000

出　　处：《河北医学》2021年第6期980-986,共7页Hebei Medicine

基　　金：陕西省科学技术重点研发计划项目,(编号:2017K14-02-13)。

摘　　要：目的:探讨传统后正中入路、椎旁肌间隙入路与微创经皮入路治疗胸腰椎骨折的临床效果。方法:选取研究对象为150例胸腰椎骨折,研究时间为2017年1月至2019年12月,按照随机数字表法分为A组(予以椎旁肌间隙入路组行手术治疗,n=60)、B组(予以微创经皮入路行手术治疗,n=30)、C组(予以传统后正中入路行手术治疗,n=60);对比三组TNF-α、MCP-1、HMGB-1、CRP、IL-1β、OC、OPG、PICP、PINP、TRACPsb、RANKL、β-CTx、NTX指标,以及评估手术时间、术中出血量、住院时间、切口长度。结果:重复测量方差分析显示,三组TNF-α、MCP-1、HMGB-1、CRP、IL-1β、OC、OPG、PICP、PINP、TRACPsb、RANKL、β-CTx、NTX的时点、组间、交互比较均存在显著差异(P<0.05)。单因素方差显示,术前,三组TNF-α、MCP-1、HMGB-1、CRP、IL-1β、OC、OPG、PICP、PINP、TRACPsb、RANKL、β-CTx、NTX比较无显著差异(P>0.05);术后48h,A组的TNF-α、MCP-1、HMGB-1、CRP、IL-1β、TRACPsb、RANKL、β-CTx、NTX低于B、C组,而OC、OPG、PICP、PINP高于B、C组,而低于B、C组(P<0.05)。A组的手术时间短于B、C组(P<0.05);A组术中出血量低于C组(P<0.05);A组的术中出血量与B组相比,差异无统计学意义(P>0.05);三组的住院时间相比,差异无统计学意义(P>0.05)。结论:三种手术入路相比,但椎旁肌间隙入路效果更优,即手术时间短,炎症反应小。Objective:To explore the clinical effects of traditional posterior median approach,paraspinal muscle approach and minimally invasive percutaneous approach in the treatment of thoracolumbar fractures.Methods:The selected study subjects were 150 cases of thoracolumbar fractures from January 2017 to December 2019,and they were divided into group A(the paraspinal muscle space approach group received surgical treatment,n=60),Group B(surgery with minimally invasive percutaneous approach,n=30),and group C(surgery with traditional posterior median approach,n=60)according to the random number table.The study compared the three groups of TNF-α,MCP-1,HMGB-1.CRP,IL-1β,OC,OPG,PICP,PINP,TRACPsb,RANKL,β-CTx,NTX indicators,as well as evaluation of operation time,intraoperative blood loss,hospital stay,and incision length.Results:Repeated measures analysis of variance showed significant difference between the three groups of TNF-α,MCP-1,HMGB-1,CRP,IL-1β,OC,OPG,PCP,PINP,TRACPsb,RANKL,β-CTx,NTX time point.(P<0.05).One-way variance showed that there was no significant difference between the three groups of TNF-α,MCP-1,HMGB-1,CRP,IL-1β,OC,OPG,PICP,PINP,TRACPsb,RANKL,β-CTx,NTX before surgery(P>0.05);48h after operation,TNF-α,MCP-1,HMGB-1,CRP,IL-1β,TRACPsb,RANKL,β-CTx,NTX in group A were lower than those in groups B and C,while OC and OPG,PICP and PINP were higher than those in groups B and C,but lower than those of B and C groups(P<0.05).The operation time of group A was shorter than that of group B and C(P<0.05);the blood loss of group A was lower than group C(P<0.05);the blood loss of group A was not significantly different from group B(P>0.05).Comparison of the length of hospital stay of the three groups showed no significant difference(P>0.05).Conclusion:Comparison of the three surgical approaches revealed the paraspinal space approach is more effective,that is,the operation time is short and the inflammation is small.

关 键 词：传统后正中入路 椎旁肌间隙入路 微创经皮入路 胸腰椎骨折 

分 类 号：R58[医药卫生—内分泌]