摘要
目的比较胸腰椎骨折后路椎弓根螺钉内固定手术两种显露方式的临床效果。方法将84例胸腰椎骨折患者按手术显露方式的不同分为两组:椎旁肌间隙入路显露33例(A组);传统后入路显露51例(B组)。比较两组的手术时间、术中出血量、术后引流量、VAS疼痛评分、切口并发症、椎体高度矫正率、Cobb角矫正率、Oswestry功能障碍指数等各项临床指标,比较两组治疗效果。结果两组手术时间、术中出血量、术后引流量、VAS疼痛评分、切口并发症比较A组优于B组,差异有统计学意义(P<0.05);而椎体高度矫正率、Cobb角矫正率、Oswestry功能障碍指数两组比较差异无统计学意义(P>0.05)。结论椎旁肌间隙入路显露方式与传统后入路显露方式比较,具有手术操作简单、软组织损伤小、术中出血少等优势,但因术中暴露范围有限,在手术适应证上有其局限性。术中需行椎板开窗探查、减压、椎管内骨块复位以及不稳定脊柱骨折需加用横连接、棘突钢丝内固定者,应选传统后入路显露方式。
Objective To study the clinical effects of two thoracolumbar posterior approaches for thoracolumbar fractures by internal fixation with pedicle-screw. Methods 84 cases of thoracolumbar spinal fractures were included in this study. 33 cases were treated by internal fixation from thoracolumbar vertebra-side muscle clearance（ Group A ）and 51 cases were treated from conventional approach （ Group B） , and the curative effects were comparatively observed. The following date were compared：operative time, blood loss, postoperative drainage, pain degree （visual analogue score,VAS） ,the incidence of incision complications,correct rate of vertebral body height and Cobb angle,and Oswestly disability questionnaire. Results There was no significant difference in correct-rate of vertebral body height and Cobb angle,and in Oswestry disability questionnaire （ P 〉 0. 05 ）. But shorter operative time,less blood loss,less post- operative back pain ,lower the incidence of incision complications were found in Group A（ P 〈 O. 05 ）. Conclusions Compared with conventional approach,thoracolumbar vertebra-side muscle clearance approach has the advantages of handy operation, less soft tissue injury and blood loss ,however, it has limitations of surgical indication because of the limited expose scope. At the state of laminectomy for exanfination,decompression, reducetion the intraspinal fracture and internal fixation for unstable fracture by transverse connecting bar with spinous process wire, the conventional approach should be chose.
出处
《临床骨科杂志》
2011年第1期15-17,共3页
Journal of Clinical Orthopaedics
关键词
椎旁肌间隙入路
传统腰椎入路
胸腰椎骨折
骨折固定术
from thoracolumbar vertebra-side muscle clearance
traditional vertebral path
thoracolumbar fractures
fracture fixation
