肌间隙入路与后正中入路在胸腰椎骨折后路内固定术中应用的比较研究  

Intramuscular space approach versus posterior midline approach in posterior internal fixation of thoracolumbar fractures

作　　者：李石旦 王绍川 李又彬 谢晓瑜 邢伟 吴黎明 徐宏皓 费军 LI Shidan;WANG Shaochuan;LI Youbin;XIE Xiaoyu;XING Wei;WU Liming;XU Honghao;FEI Jun(Department of Orthopaedics,Army Medical Center of Chinese People's Liberation Army,Daping Hospital,Third Military Medical University,Chongqing 400002,China;Institute of Field Surgery,Army Medical Center of Chinese People's Liberation Army,Daping Hospital,Third Military Medical University,Chongqing 400002,China;Department of Orthopaedics,Chongqing Public Health Medical Center,Chongqing 400030,China;Department of Emergency,Army Medical Center of Chinese People's Liberation Army,Daping Hospital,Third Military Medical University,Chongqing 400002,China)

机构地区：[1]中国人民解放军陆军特色医学中心骨科,重庆400002 [2]中国人民解放军陆军特色医学中心野战外科研究所,重庆400002 [3]重庆市公共卫生医疗救治中心骨科,重庆400030 [4]中国人民解放军陆军特色医学中心急诊医学科,重庆400002

出　　处：《中华骨与关节外科杂志》2024年第9期794-799,共6页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金青年项目(82302435);陆军军医大学战团建设项目。

摘　　要：目的:分析肌间隙入路与后正中入路在胸腰椎骨折后路内固定术中应用的优劣势。方法:回顾性分析2010年1月至2022年12月中国人民解放军陆军特色医学中心收治的328例接受后路内固定术的胸腰椎骨折患者的临床资料。其中217例患者采取后正中入路(后正中入路组),111例患者采取肌间隙入路(肌间隙入路组)。比较两组患者住院及手术情况、血液学指标,同时比较手术医师对两组手术入路的主观感受评分。结果:与后正中入路组患者比较,肌间隙入路组患者手术时间更短,术中补液量、术后引流量更少,住院费用更低,且差异均有统计学意义(P均<0.05),两组患者手术切口长度、术中出血量、住院时间及术中输血、术后转ICU、术后1年内感染、二期翻修情况差异均无统计学意义(P均>0.05)。两组患者手术前后K+、尿素、肌酐、天冬氨酸转氨酶(AST)、谷丙转氨酶(ALT)、红细胞沉降率、血红蛋白、红细胞压积、C反应蛋白(CRP)异常情况差异均无统计学意义(P均>0.05)。手术医师对后正中入路手术在主刀视野、助手视野、拉钩、放置椎弓根螺钉、放置连接杆及缝合方面的主观感受评分均高于肌间隙入路手术,且差异均有统计学意义(P均<0.05)。结论:胸腰椎骨折患者行后路内固定术,肌间隙入路在手术时间、术中补液量、术后引流量、住院费用等方面优于后正中入路;后正中入路在术中手术医师操作的舒适度方面优于肌间隙入路。Objective:To analyze the advantages and disadvantages of the intramuscular space approach and the posterior midline approach in posterior internal fixation of thoracolumbar fractures.Methods:From January 2010 to December 2022,the clinical data of 328 patients who underwent posterior internal fixation for thoracolumbar fractures at the Army Medical Center of the Chinese People's Liberation Army were retrospectively analyzed.Among these patients,217 underwent the intramuscular space approach(intramuscular space approach group),and 111 underwent the posterior midline approach(intramuscular space approach group).The hospitalization,operation,and hematological indicators of the two groups were compared,and the surgeons'subjective perception scores for the surgical approaches were also compared.Results:Compared with in the posterior midline approach group,patients in the intramuscular space approach group had shorter operation times,less intraoperative rehydration volume and postoperative drainage volume,and lower hospital cost(all P<0.05).However,there were no significant differences in incision length,intraoperative blood loss,hospitalization duration,volume of intraoperative blood transfusion,number of postoperative ICU transfers,number of postoperative infections,or number of the second-phase renovations(all P>0.05).There were also no statistically significant differences in the abnormal levels of potassium ions,urea,creatinine,aspartate aminotransferase,alanine aminotransferase,erythrocyte sedimentation rate,hemoglobin,hematocrit,or C-reactive protein before and after surgery between the two groups(all P>0.05).The subjective perception scores of surgeons for the posterior midline approach were significantly higher than those for the intramuscular space approach in the terms of the main surgeon's visual field,assistant's visual field,hooks,pedicle screw placement,connecting rods placement and suturing(all P<0.05).Conclusions:The intramuscular space approach is superior in the operation time,intraoperative rehydrati

关 键 词：脊柱骨折 脊柱后路手术 肌间隙入路 后正中入路 

分 类 号：R683.2[医药卫生—骨科学]