改良后椎旁入路与传统后正中入路椎弓根螺钉内固定术治疗胸腰椎骨折的疗效对比

摘要

目的：探讨改良后椎旁入路与传统后正中入路椎弓根螺钉内固定术（ pedicle screw fixation ， PSF）治疗胸腰椎骨折（ thoracic and lumbar fracture ，TALF）的疗效。方法笔者抽选2010年2月～2014年2月收治的98例TALF患者，均予以PSF治疗，根据入路方式不同分为对照组（ n＝49，采用传统后正中入路）和观察组（ n＝49，采用改良后椎旁入路），比较两组手术相关指标、伤椎前缘高度、Cobb角矫正度的差异。观察患者术后疼痛视觉模拟评分（ VAS）、血肌酸激酶同工酶（ CK－MB）的变化。结果观察组手术时间、出血量及引流量明显低于对照组（ P＜0．05）。两组患者术后伤椎前缘高度、Cobb角矫正度均明显优于术前（ P＜0．05）；但组间比较差异无显著性（P＞0．05）。观察组术后2周、1个月VAS评分，术后1、3d CK－MB水平明显低于对照组（P＜0．05）。结论改良后椎旁入路手术时间短、功能恢复快，与传统后正中入路相比，具有创伤小、手术损伤少、患者术后腰背疼痛缓解明显的特点，值得临床推广。%Objective To investigate the therapeutic effect of pedicle screw fixation via modified posterior ap-proach and conventional posterior median approach in the treatment of thoracolumbar vertebral fracture .Methods Nine-teen-eight cases of thoracolumbar vertebral fractures were selected in our hospital from Feb .2010 to Feb.2014,who were treated by pedicle screw fixation (PSF).Patients were divided into the control group(n=49 cases,using the traditional method) and the observation group(n=49 cases,using modified posterior approach).The differences of operation re-lated indexes , the height of the injured vertebral body and the correction of Cobb angle were compared between the two groups.Visual analog scale (VAS) and serum creatine kinase isoenzyme (CK-MB) were observed.Results The op-eration time,bleeding volume and drainage rate of the observation group were significantly lower than those in the con -trol group(P<0.05).In the two groups, the height of the injured vertebral body and the Cobb angle after operation were significantly better than those before operation (P<0.05),but there was no significant difference between the two groups after operation ( P>0.05 ) .The VAS score at 2 weeks and 1 month after operation in the observation group was significantly lower than that of the control group ,CK-MB at postoperative days 1 and 3 in the observation group was significantly lower than that of the control group (P<0.05).Conclusion Compared with the conven-tional posterior median approach , modified posterior vertebral approach for treating thoracolumbar vertebral fractures has advantages of short operation time ,rapid functional recovery ,less trauma,less surgical injury,and obvious pain relief,which is worth to be widely applied in clinical practice .