摘要
目的比较后路经皮内固定术与经多裂肌和最长肌间隙入路内固定术治疗无神经症状的胸腰椎骨折的疗效。方法回顾性分析2014年2月—2016年10月收治的62例无神经症状的胸腰椎骨折病例,其中采用后路经皮内固定术治疗30例(A组),采用经多裂肌和最长肌间隙入路内固定术治疗32例(B组)。记录并比较2组的手术时间、术中出血量、术中透视次数,以及术前术后各随访时间点的疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、伤椎前缘相对高度及Cobb角。结果所有患者随访1224个月,平均16个月。2组术后各时间点VAS评分、ODI、伤椎前缘相对高度及Cobb角均较术前明显改善,差异有统计学意义(P <0.05)。与A组相比,B组手术时间短,术中出血量大,术中透视次数少,术后1 d、1周的VAS评分低,差异均有统计学意义(P <0.05)。结论 2种术式治疗无神经症状的胸腰椎骨折均可获得良好的临床效果,但在手术时间、术中辐射暴露、术后早期疼痛缓解以及预防腰椎手术失败综合征等方面,经多裂肌和最长肌间隙入路内固定术更具优势。
Objective To compare the efficacy of posterior percutaneous internal fixation and internal fixation via multifidus and longissimus intermuscular approach in the treatment of thoracolumbar fractures without neurological symptoms. Methods From February 2014 to October 2016,62 cases of thoracolumbar fractures without neurological symptoms were analyzed retrospectively. Thirty cases were treated with posterior percutaneous internal fixation(group A) and 32 with internal fixation via multifidus and longissimus intermuscular approach(group B). The operation time,intraoperative blood loss, intraoperative fluoroscopy times,and pain visual analogue scale(VAS),Oswestry dysfunction index(ODI),relative anterior height of injured vertebra and Cobb’s angle at preoperative and each follow-up time points were recorded and compared between the 2 groups. Results All the patients were followed up for 12 - 24 months(mean 16 months). The VAS score,ODI,relative anterior height of injured vertebra and Cobb’s angle of the 2 groups at each time point after operation were significantly improved compared with those before operation,and the differences were statistically significant(P < 0.05). Compared with group A, group B had shorter operation time,larger blood loss,fewer fluoroscopy times and lower VAS scores at postoperative 1 d and 1 week,and the differences were statistically significant(P < 0.05). Conclusion Both of the 2 methods can achieve good clinical results in the treatment of thoracolumbar fractures without neurological symptoms. However,the internal fixation via multifidus and longissimus intermuscular approach is more advantageous in terms of operation time,intraoperative radiation exposure,early postoperative pain relief and prevention of failed back surgery syndrome.
作者
罗学勤
陆青
LUO Xue-qin;LU Qing(Department of Orthopaedics,PKUCare Luzhong Hospital,Zibo 255400,Shandong,China;Department of Neurolog,PKUCare Luzhong Hospital,Zibo 255400,Shandong,China)
出处
《脊柱外科杂志》
2019年第2期90-94,共5页
Journal of Spinal Surgery
关键词
胸椎
腰椎
脊柱骨折
内固定器
Thoracic vertebrae
Lumbar vertebrae
Spinal fractures
Internal fixators
