CAJ | 학술논문

目的：研究椎旁肌间隙入路和传统后正中入路治疗无神经症状的胸腰椎骨折的临床疗效及对椎旁肌的影响。方法2011年7月～2012年7月我院骨科预行椎弓钉短节段内固定术的胸腰椎骨折患者82例，随机分成2组，椎旁肌间隙入路39例（A组），传统后正中入路43例（B组），对两组的临床疗效指标进行统计分析；术后1年取出内固定时切取少量椎旁肌行HE染色做组织切片，对两组切片进行观察比较。结果两组手术时间、术中出血量、切口内残腔体积、术后引流量、术后视觉模拟评分（visual analogue scale，VAS）评分，A组均低于B组，差异有统计学意义（P＜0.05）。两组手术切口长度无显著差异（P＞0.05）。术后24、72h的肌酸磷酸激酶（Creatine kinases，CK）值，A组极显著低于B组（P＜0.01），而术后1周两组CK值恢复至正常水平，差异无统计学意义（P＞0.05）。两组手术方式均能明显矫正后凸角和压缩椎体前缘高度，术后椎体前、后缘高度与伤椎上、下椎体的前、后缘高度平均值比和Cobb角与术前相比，无显著差异（P＞0.05）。组织切片示传统后正中入路组椎旁肌肌纤维萎缩变细甚至消失、排列紊乱、肌丝崩解，肌纤维间瘢痕形成，肌纤维脂肪沉积；而椎旁肌间隙入路组肌纤维无明显萎缩、排列有序正常，肌纤维未见明显退变，无瘢痕形成，无脂肪沉积。结论经椎旁肌间隙入路短节段椎弓根钉固定术治疗无神经症状的胸腰椎骨折，能有效恢复椎体高度和纠正后凸角度，与传统后正中入路相比，具有手术创伤小、出血量少、手术时间短，不损伤椎旁肌，减少术后腰背肌疼痛等优点。
목적：연구추방기간극입로화전통후정중입로치료무신경증상적흉요추골절적림상료효급대추방기적영향。방법2011년7월～2012년7월아원골과예행추궁정단절단내고정술적흉요추골절환자82례，수궤분성2조，추방기간극입로39례（A조），전통후정중입로43례（B조），대량조적림상료효지표진행통계분석；술후1년취출내고정시절취소량추방기행HE염색주조직절편，대량조절편진행관찰비교。결과량조수술시간、술중출혈량、절구내잔강체적、술후인류량、술후시각모의평분（visual analogue scale，VAS）평분，A조균저우B조，차이유통계학의의（P＜0.05）。량조수술절구장도무현저차이（P＞0.05）。술후24、72h적기산린산격매（Creatine kinases，CK）치，A조겁현저저우B조（P＜0.01），이술후1주량조CK치회복지정상수평，차이무통계학의의（P＞0.05）。량조수술방식균능명현교정후철각화압축추체전연고도，술후추체전、후연고도여상추상、하추체적전、후연고도평균치비화Cobb각여술전상비，무현저차이（P＞0.05）。조직절편시전통후정중입로조추방기기섬유위축변세심지소실、배렬문란、기사붕해，기섬유간반흔형성，기섬유지방침적；이추방기간극입로조기섬유무명현위축、배렬유서정상，기섬유미견명현퇴변，무반흔형성，무지방침적。결론경추방기간극입로단절단추궁근정고정술치료무신경증상적흉요추골절，능유효회복추체고도화규정후철각도，여전통후정중입로상비，구유수술창상소、출혈량소、수술시간단，불손상추방기，감소술후요배기동통등우점。
Objective To compare the clinical outcome and the impacts of paraspinal approach and con-ventional approach in treating thoracolumbar fractures without neurological symptoms .Methods From Jul.2011 to Jul.2012,eighty-two patients who suffered from thoracolumbar fractures without neurological symptoms and need posterior short-segment pedicle screws fixation were included .These patients were randomly divided into 2 groups:paraspinal approach group (39 cases) and conventional approach group (22 cases).Clinical effects were accessed and measured;the pathological changes of paravertebral muscle tissue which was resected at 1 year after operation were observed and compared between the two groups .Results The surgical time,surgical blood loss,volume of re-sidual cavity,surgical draining loss,postoperative VAS (visual analogue scale) scores were lower in the paraspinal approach group than those in the conventional approach group (P<0.05).There was no difference in the length of incision between the two groups (P>0.05).The CK(Creatine kinases)value at 2 days and 3 days postoperatively was significantly lower in the paraspinal approach group than that in the conventional approach group (P<0.01). However,the CK(Creatine kinases)value recovered to normal level at 1 week postoperatively,exhibiting no statistical difference(P>0.05).Both surgical methods could obviously correct the kyphosis angle and the compression verte -bral height.There was no significant difference in the average height of anterior and posterior border of vertebral body and the Cobb angle between postoperatively and preoperatively (P>0.05).The pathological observations showed atrophy of muscle,formation of scar and deposition of fat in the conventional approach group ,whereas in the paraspinal approach group ,these conditions were notably alleviated .Conclusion The paraspinal approach for trea-ting thoracolumbar fractures without neurological symptoms can effectively recover the height of vertebral body and correct the kyphosis.Compared with the conventional approach ,the paraspinal approach has the advantages of mini-invasiveness,less bleeding,short surgical time,no injury to the paraspinal muscles and less pain to the back muscle .