摘要
目的探讨微创经皮与经肌间隙两种入路椎弓根螺钉内固定治疗单纯胸腰椎骨折的临床疗效。方法以2014年1月至2016年12月广州中医药大学附属骨伤科医院采用微创椎弓根螺钉内固定治疗的38例无神经系统损伤的单纯胸腰椎骨折患者为研究对象,根据手术入路的不同,将患者随机分为两组,其中经皮组采用经皮入路(n=19),经肌间隙组采用经肌间隙入路(n=19),记录两组切口长度、手术时间、术中出血量和术后引流量,观察手术前后腰背痛视觉模拟量表(VAS)评分以及伤椎前缘高度、矢状面椎体后凸Cobb角等影像学指标的变化。结果患者顺利完成手术。随访时间6~12个月(平均9.2个月)。两组术后VAS评分及影像学指标均较术前有明显改善(P<0.05)。经皮组切口长度、术中出血量、术后引流量、术后VAS评分均优于经肌间隙组,但手术时间长于经肌间隙组(P<0.05);两组术后1周、6个月伤椎前缘高度、伤椎矢状位后凸Cobb角比较,差异无统计学意义(P>0.05)。结论采用微创经皮与经肌间隙两种入路椎弓根螺钉内固定治疗单纯胸腰椎骨折均能取得满意疗效;与经肌间隙入路相比,经皮入路具有出血少、手术损伤小、术后恢复快、疼痛缓解迅速等优点。
Objective To explore the therapeutic effects of minimally invasive pedicle screw fixation through percutaneous or paraspinal approach in the treatment of thoracolumbar fractures.Methods A total of 38 simple thoracolumbar fracture patients without neurological symptoms treated by minimally invasive pedicle screw fixation from January 2014 to December 2016 in the Orthopaedic Hospital Affiliated to Guangzhou University of TCM were included in the study.They were divided into two groups randomly according to the different surgical approaches,patients in percutaneous group were treated with percutaneous approach(n=19),while patients in paraspinal group with paraspinal approach(n=19).The length of incision,operation time,intraoperative estimate blood loss and postoperative drainage were recorded,preoperative and postoperative back pain visual analogue scale(VAS)score,and imaging parameters such as anterior height of injured vertebra and vertebral kyphosis sagittal Cobb angle were observed in both groups.Results All patients underwent the operations smoothly.The average follow-up time was 9.2 months(6 to 12 months).In both groups,VAS scores and the imaging parameters improved significantly after the surgery(P<0.05).The incision length,intraoperative estimate blood loss,postoperative drainage and postoperative VAS score in percutaneous group were better than those in paraspinal group,while the operation time was longer in percutaneous group(P<0.05);There were no significant differences in anterior height of injured vertebrae and sagittal kyphosis Cobb angle at 1 week and 6 months postoperatively between two groups(P>0.05).Conclusions For simple thoracolumbar fractures,minimally invasive pedicle screw fixation by either percutaneous or paraspinal approach could achieve satisfactory clinical effect.Comparing with paraspinal approach,percutaneous approach has the advantages of less bleeding,less surgical injury,faster postoperative recovery and rapid pain relief.
作者
朱辉
原超
张文财
ZHU Hui;YUAN Chao;ZHANG Wencai(Department of Spine,the Orthopaedic Hospital Affiliated to Guangzhou University of TCM,Guangzhou,Guangdong 510240,China)
出处
《中国骨科临床与基础研究杂志》
2018年第1期27-32,共6页
Chinese Orthopaedic Journal of Clinical and Basic Research
关键词
胸椎
腰椎
脊柱骨折
骨折固定术
内
椎弓根螺钉
外科手术
微创性
经皮入路
经肌间隙入路
Thoracic vertebrae
Lumbar vertebrae
Spinal fractures
Fracture fixation,internal
Pedicle screw
Surgical procedures,minimally invasive
Percutaneous approach
Paraspinal approach
