后肌间隙入路固定无神经损伤胸腰椎骨折

吴强

[摘要] 目的 探讨无神经损伤胸腰椎骨折经后路多裂肌与最长肌肌间隙入路椎弓根螺钉系统固定的临床疗效。探讨胸腰椎骨折后路内固定的显露方法。方法 通过对2009年3月—2013年6月收治的80例无神经损伤胸腰椎骨折分成甲、乙两组，每组40例。采用后路多裂肌与最长肌肌间隙入路椎弓根螺钉系统固定的患者为甲组，采用传统后入路的为乙组。比较两组的临床疗效。结果 甲组在手术时间、术中出血量、术后疼痛（VAS评分）、术后积液引流、切口愈合以及并发症方面明显优于乙组，差异有统计学意义（P<0.05）。cobb角、椎体高度矫正两组比较差异无统计学意义（P>0.05）。结论 经后路多裂肌与最长肌肌间隙入路椎弓根螺钉系统固定无神经损伤胸腰椎骨折是确切有效的方法，它具有操作容易、软组织受损轻微、术中术后出血量少、手术时间短、术后恢复快、并发症少等优点。

[关键词] 胸腰椎骨折；后路肌间隙入路；椎弓根螺钉内固定

[中图分类号] R68 [文献标识码] A [文章编号] 1674-0742（2015）08（c）-0077-02

Posterior Paramedian Approach in Internal Fixation for Thoracolumbar Fracture Without Neurologic Injury

WU Qiang

Department of Orthopedics， Red Cross Hospital of Tongchuan District， Dazhou， Sichuan Province， 635000 China

[Abstract] Objective To investigate the clinical effect of pedicle screw fixation via multifidus and longissimus patium approach in the treatment of thoracolumbar fracture without neurologic injury and discuss its exposure method. Methods 80 patients with thoracolumbar fracture without nerve injury admitted between March 2009 and June 2013 were divided into group A and group B with 40 in each one. Pedicle screw fixation via multifidus and longissimus patium approach was performed in the group A， while internal fixation by traditional posterior approach in the group B. The clinical effects were compared between the two groups. Results In terms of operation duration， intraoperative blood loss， VAS score， drainage flow， wound healing and complication， the group A was superior to the group B with statistically significant differences， P<0.05. No statistically significant differences were observed in Cobb angle and vertebral height correction between the two groups， P>0.05. Conclusion Pedicle screw fixation via multifidus and longissimus patium approach in the treatment of thoracolumbar fracture without neurologic injury has exact curative effect and advantages of easy operation， less soft tissue injuries， less blood loss and operation duration， quick recovery and high safety etc.

[Key words] Thoracolumbar fracture； Posterior paramedian approach； Pedicle screw fixation

为分析无神经损伤胸腰椎骨折经后路多裂肌与最长肌肌间隙入路椎弓根螺钉系统固定的临床疗效。该研究选取2009年3月—2013年6月间该院收治的80例无神经损伤脸腰椎骨折患者为研究对象，对其进行分析，现报道如下。

1 资料与方法

1.1 一般资料

随机选取2009年3月—2013年6月该院收治的80例无神经损伤胸腰椎骨折患难者为研究对象，80例均为新鲜骨折，伤后1～15 d接受手术。男性53例，女性27例。年龄20～60岁。平均45岁。按胸腰椎骨折Denis分型；压缩性骨折60例，爆裂性骨折20例，骨折部位：胸10椎体骨折10例，胸11、12椎体20例，腰1椎体20例、腰2椎体20例。……