CAJ | 학술논문

背景：脊柱后路手术是胸腰段椎体骨折最常用的治疗方法，传统后路手术显露过程中，大范围椎旁肌的剥离和牵拉，容易发生腰椎手术失败综合征。 　　目的：比较椎弓根螺钉椎旁肌间隙入路与传统后正中入路内固定修复胸腰椎骨折的复位情况及稳定性。 　　方法：对62例无神经损伤胸腰椎骨折的患者进行回顾性分析，采用椎旁肌间隙入路并GSS内固定系统治疗22例，传统正中入路并GSS内固定系统治疗21例，传统正中入路并AF内固定系统治疗19例。通过比较3组患者的手术时间、术中出血量、术后引流量、术毕切口内残腔体积、腰背痛目测类比评分、切口并发症、伤椎高度、Cobb角等各项临床指标，对比3种内固定方案的治疗效果。 　　结果与结论：3组患者手术时间、术中出血量、术毕切口内残腔体积、内固定后引流量比较，椎旁肌间隙入路并GSS内固定组优于传统正中入路并GSS内固定组及传统正中入路并AF内固定组(P<0.05)。3组内固定后3 d椎体高度、Cobb角比较，差异无显著性意义(P>0.05)。腰痛目测类比评分内固定后1周3组差异无显著性意义(P>0.05)，内固定后3，6个月椎旁肌间隙入路并GSS内固定组明显低于传统正中入路并GSS内固定组及传统正中入路并AF内固定组。3组患者均未见切口感染。提示椎旁肌间隙入路显露方式与传统后入路显露方式比较，具有创伤小，出血少，术后恢复快、患者满意度高等优势，GSS内固定系统与AF内固定系统修复胸腰椎骨折内固定效果相近，但GSS内固定系统操作简单，具有省时、出血量少、固定牢靠和复位良好的优点，结合椎旁肌入路，是目前修复胸腰段脊柱骨折较好的方法之一。
배경：척주후로수술시흉요단추체골절최상용적치료방법，전통후로수술현로과정중，대범위추방기적박리화견랍，용역발생요추수술실패종합정。 　　목적：비교추궁근라정추방기간극입로여전통후정중입로내고정수복흉요추골절적복위정황급은정성。 　　방법：대62례무신경손상흉요추골절적환자진행회고성분석，채용추방기간극입로병GSS내고정계통치료22례，전통정중입로병GSS내고정계통치료21례，전통정중입로병AF내고정계통치료19례。통과비교3조환자적수술시간、술중출혈량、술후인류량、술필절구내잔강체적、요배통목측류비평분、절구병발증、상추고도、Cobb각등각항림상지표，대비3충내고정방안적치료효과。 　　결과여결론：3조환자수술시간、술중출혈량、술필절구내잔강체적、내고정후인류량비교，추방기간극입로병GSS내고정조우우전통정중입로병GSS내고정조급전통정중입로병AF내고정조(P<0.05)。3조내고정후3 d추체고도、Cobb각비교，차이무현저성의의(P>0.05)。요통목측류비평분내고정후1주3조차이무현저성의의(P>0.05)，내고정후3，6개월추방기간극입로병GSS내고정조명현저우전통정중입로병GSS내고정조급전통정중입로병AF내고정조。3조환자균미견절구감염。제시추방기간극입로현로방식여전통후입로현로방식비교，구유창상소，출혈소，술후회복쾌、환자만의도고등우세，GSS내고정계통여AF내고정계통수복흉요추골절내고정효과상근，단GSS내고정계통조작간단，구유성시、출혈량소、고정뢰고화복위량호적우점，결합추방기입로，시목전수복흉요단척주골절교호적방법지일。
BACKGROUND:Spinal posterior surgery is the most common treatment method for thoracolumbar fracture. During exposure of conventional posterior surgery, a wide-range stripping and pul ing of paraspinal muscles easily induced failure syndrome of lumbar surgery. OBJECTIVE:To compare the reset conditions and stability of thoracolumbar fractures after treatment with pedicle screw paraspinal muscle approach and conventional posterior median approach fixation. METHODA total of 62 patients with thoracolumbar fractures without nerve injury were retrospectively analyzed. 22 patients were treated with paraspinal muscle approach and general spine system. 21 patients were treated with conventional median approach and general spine system. 19 patients were treated with conventional median approach and AF internal fixation system. The therapeutic effects of the three kinds of fixation methods were compared by comparing clinical indexes in patients of the three groups, including operation time, intraoperative blood loss, postoperative drainage, dead space volume, scores of the Visual Analogue Scale of back pain, wound complications, height of injured vertebrae and the Cobb angle. RESULTS AND CONCLUSION:Operation time, intraoperative blood loss, postoperative drainage and dead space volume were better in the paraspinal muscle approach and general spine system group than in the conventional median approach and general spine system group and conventional median approach and AF internal fixation system group (P<0.05). No significant difference in height of injured vertebrae and the Cobb angle was detectable among the three groups at 3 days after fixation (P>0.05). No significant difference in scores of the Visual Analogue Scale of back pain was visible among the three groups at 1 week after fixation (P>0.05). The scores of the Visual Analogue Scale of back pain were apparently lower in the paraspinal muscle approach and general spine system group than in the conventional median approach and general spine system group and conventional median approach and AF internal fixation system group at 3 and 6 months after fixation. No incision infection was observed in patients of the three groups. These results suggested that compared with conventional posterior median approach, paraspinal muscle approach has some advantages, such as smal trauma, less bleeding, postoperative rapid recovery, and high degree of satisfaction. The effects of general spine system and AF internal fixation system in the repair of thoracolumbar fractures on internal fixation are similar, but general spine system has some advantages such as simple to be operated, save time, less bleeding, stable fixation and good reduction. General spine system combined with paraspinal muscle approach is a good method to repair thoracolumbar spine fracture.