椎旁肌间隙入路与传统后正中入路在胸腰椎后路手术中的应用比较

Comparision between paraspinal muscle space approach versus conventional posterior midline approach in thoracolumbar posterior surgery

中文关键词:  胸椎  腰椎  脊柱骨折  手术入路  疗效

英文关键词:Thoracic vertebrae  Lumbar vertebrae  Spinal fractures  Operative approach  Therapeutic effect

中文摘要:

  【摘要】 目的：比较经椎旁肌间隙入路与传统后正中入路对胸腰椎后路手术疗效的影响。方法：回顾2008年6月～2011年10月收治的行单节段椎弓根钉棒系统撑开复位内固定或需拆除内固定手术的67例患者（骨折病例为单节段胸腰椎压缩性或爆裂性骨折但无神经症状不需行椎管减压的患者）。患者分为2组：传统后正中入路组31例，男25例，女6例，平均年龄31.4岁，术前腰背痛VAS评分7.9±0.6分，Cobb角20.1°±3.5°，累及T11椎体5例，T12椎体12例，L1椎体12例，L2椎体2例；椎旁肌间隙入路组36例，男31例，女5例，平均年龄32.9岁，术前腰背痛VAS评分7.6±0.8分，Cobb角19.8°±4.1°，累及T11椎体8例，T12椎体13例，L1椎体13例，L2椎体2例。比较2组的手术时间、术中出血量、术后引流量、Cobb角矫正率及术后腰背部疼痛VAS等指标。结果：手术均顺利完成，所有患者获得随访，随访时间为3～8个月。术后Coob角矫正率及椎弓根螺钉置入准确率后正中入路组分别为（87.4±5.3）%和（96.4±2.8）%；椎旁肌间隙入路组分别为（86.7±6.5）%和（96.7±3.3）%，两组间差异无统计学意义（P＞0.05）。手术时间、术中出血量及术后引流量椎旁肌间隙入路组分别为75.0±18.1min、140.0±40.7ml及85.0±25.2ml；传统入路组分别为93.0±15.7min、230.0±35.5ml及160.0±43.5ml，椎旁肌间隙入路组明显少于传统入路组（P＜0.05）。术后1、2、3周时的疼痛VAS评分椎旁肌间隙入路组分别为3.6±0.5、2.9±0.5及1.5±0.4分，后中入路组分别为4.9±0.6、4.1±0.6及2.8±0.4分，术后1周时两组间无显著性差异（P＞0.05）；术后2、3周时椎旁肌间隙入路组明显低于后正中入路组（P＜0.05）。结论：在行腰椎后路手术时，椎旁肌间隙入路与传统后正中入路相比，具有创伤小、对椎旁肌的损伤少及术后腰背部疼痛缓解明显的优点。

英文摘要:

  【Abstract】 Objectives: To compare the clinical results between paraspinal muscle space approach and conventional posterior midline approach in thoracolumbar posterior surgery． Methods: From June 2008 to October 2011, 67 patients underwent single segment instrumentation(pedicle screw system) or internal fixation removal(pedicle screw system). For cases with spine facture, the fracture type was single segment compressional or burst fracture with no neurological deficit. The patients were divided into 2 groups: conventional posterior midline approach group included 31 cases, 25 males and 6 females, with an average age of 31.4 years. The involved segments included 5 T11, 12 T12, 12 L1 and 2 L2. The preoperative visual analog scale was 7.9±0.6, and the Cobb angle was 20.1°±3.5°. Paraspinal approach group included 36 cases, 31 males and 5 females, with an average age of 32.9 years. The involved segments included 8 T11, 12 T12, 13 L1, 2 L2. The preoperative visual analog scale was 7.6±0.8, and the Cobb angle was 19.8°±4.1°. The data including operation time, intraoperative blood loss, postoperative volume of drainage, correction rate of Cobb angle and VAS scores between 2 groups were compared． Results: All operations were completed successfully. All patients were followed up for 3-8 months． In the conventional posterior midline approach group, the postoperative correction rate of Cobb angle and the accuracy of pedicle screw placement was (87.4±5.3)% and (96.4±2.8)% respectively, which was (86.7±6.5)% and (96.7±3.3)% in the paraspinal approach group. There were no significant differences between two groups(P＞0.05). But, the operation time, intraoperative blood loss and postoperative volume of drainage was 75.0±18.1min, 140.0±40.7ml, 85.0±25.2ml respectively in the paraspinal approach group, and 93.0±15.7min, 230.0±35.5ml, 160.0±43.5ml in the posterior midline approach group respectively. The paraspinal approach group was significantly superior than the posterior midline approach group(P＜0.05). In the paraspinal approach group, the VAS score was 7.6±0.8, 2.9±0.5, 1.5±0.4 at postoperative 1, 2 and 3 weeks respectively, which was 7.9±0.6, 4.1±0.6, 2.8±0.4 in the posterior midline approach group respectively. Although there was no significance difference at the first week(P＞0.05), the paraspinal approach group showed the significant superiority to posterior midline approach group(P＜0.05) at postoperative 2 and 3 weeks． Conclusions: The paraspinal approach is better than the posterior midline approach for posterior thoracolumbar surgery，which develops less injury and more relief of postoperative low back pain．