经椎旁肌入路与传统入路治疗胸腰段骨折疗效比较
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[摘要] 目的 探讨脊柱经椎旁肌入路和传统入路安置椎弓根螺钉器械复位固定治疗胸腰段骨折的临床疗效。 方法 43例无神经损伤的胸腰段骨折，其中22例行椎旁肌入路手术，另21例行传统后正中入路手术，均行后路椎弓根螺钉复位固定，比较两种入路临床疗效。 结果 通过12～18个月随访（平均15个月），经椎旁肌入路与传统入路在手术时间、Cobb角矫正率、椎体塌陷矫正率、拆除内固定前JOA评分无统计学意义，经椎旁肌入路较传统入路在术中出血量、术后引流量、卧床时间及术后疼痛视觉模拟评分（VAS）等方面均有统计学意义。 结论 经椎旁肌入路与传统实用入路比较，进行椎弓根螺钉置入保护了椎旁肌，出血少，微创、安全、实用，术后卧床时间短，腰背部疼痛轻，疗效满意。
[关键词] 胸腰椎骨折；手术入路
[中图分类号] R687.3 [文献标识码] B [文章编号] 1673—9701（2012）25—0136—03
The comparison of paraspinal approach and traditional approach in treatment of thoracolumbar tractures
ZHANG Yun LEI Zhifu LUO Bin CHANG Jihui LI Kai TANG Yunhu DAI Jianmin FENG Bin
Department of Orthopedics，Zhongjiang County People’s Hospital in Sichuan Province， Zhongjiang 618100， China
[Abstract] Objective To assess the surgical therapeutic result of thoracolumbar fracture by pedicle screw fixation through paraspinal approach or traditional open approach. Methods From june 2008 to November 2011，43 patients with thoracolumbar ractures without neural syndromes. 22 cases with paraspinal approach group and 21 cases with conventional posterior midline approach group by pedicle screw fixation， to assess the surgical therapeutic result of thoracolumbar fracture through ，paraspinal approach or traditional open approach. Results All patients were followed up with duration form 12 to 18（mean，15 months） the differences of operation time，postoperative correction rate of Cobb angle， correction rates of collaps vertebrad and JOA scroe were’t statistically significant，the results confirmed that the parapinal approcach had obvious advantage over traditional method in blood loss，drainage，duration of recumbence and VAS， and the difference was of statistical significance. Conclusion The paraspinal approach is an better way than the traditional approach for treating of thoracolumbar fractues，which can get less trauma，less injury of paraspinal muscle ，better safty， better available and more relief of postoperative low back pain .
[Key words] Thoracolumbar fracture； Procedures approach
自从20世纪60年代椎弓根螺钉技术应用于胸腰椎固定，已取得较好效果，其经典的传统入路需椎板骨膜下剥离，椎旁肌广泛牵开显露方式，术后发生慢性腰痛、腰部平背畸形、活动受限等并发症影响临床疗效，近年逐渐被骨科医生重视。我们根据李楠等[1] 经椎旁肌入路治疗胸腰段椎体骨折的方法治疗胸腰段椎体骨折，并与传统入路比较，在减少术后并发症等方面取得满意疗效，现报道如下。
1 资料与方法
1.1一般资料
收集2008年6月～2010年11月本院收治的43例无神经损伤的胸腰段骨折患者，男28例，女15例，平均年龄44.7岁（18～62岁）。按损伤部位分T11骨折5例，T12骨折14例，L1骨折20例，L2骨折4例。按Denis分型，压缩性骨折27例，其余均爆裂骨折。本组入选标准[1]：①T11—L2为伤椎；②骨折类型为压缩性骨折或爆裂性骨折；③椎管狭窄