临床医药实践
臨床醫藥實踐
림상의약실천
PROCEEDING OF CLINICAL MEDICINE
2014年
9期
655-657
,共3页
肌间隙%椎弓根螺钉系统%研究
肌間隙%椎弓根螺釘繫統%研究
기간극%추궁근라정계통%연구
muscle approach%pedicle screw%study
目的：探讨胸腰椎椎旁肌间隙入路在胸腰椎椎弓根螺钉系统取出术中的应用。方法：选择2007年1月-2013年8月63例胸腰椎骨折后路内固定术后取出椎弓根螺钉系统的患者，随机分为后正中入路组和椎旁肌间隙入路组，其中行后正中入路取出患者30例，行椎旁肌间隙入路取出患者33例。记录并比较两组手术时间、手术出血量、术后24 h疼痛视觉模拟数字法评分（ VAS）及住院时间，并行组间比较。结果：所有患者椎弓根螺钉系统均完整拆除，无明显并发症。椎旁肌间隙入路组手术时间（38.1±5.8）min，术中出血量（52.4±7.8）mL，术后24 h及72 h患者腰背部VAS评分为（2.5±0.3）分和（0.6±0.1）分，住院时间（4.0±0.5）d。后正中入路组手术时间（76.0±8.8）min，手术出血量（186.1±25.4）mL，术后24 h及72 h患者腰背部VAS评分为（7.4±0.4）分和（2.4±0.2）分，住院时间（9.1±1.8）d。两组手术时间、手术出血量、腰背部VAS 评分及住院时间比较，差异有统计学意义（P ﹤0.05），椎旁肌间隙入路组优于后正中入路组。结论：经椎旁肌间隙入路取出胸腰椎椎弓根螺钉内固定系统有减少手术时间、术后引流量明显减少、创伤小、出血少、疼痛轻、恢复快及住院时间短等优点，是一种安全和损伤较小的术式。
目的：探討胸腰椎椎徬肌間隙入路在胸腰椎椎弓根螺釘繫統取齣術中的應用。方法：選擇2007年1月-2013年8月63例胸腰椎骨摺後路內固定術後取齣椎弓根螺釘繫統的患者，隨機分為後正中入路組和椎徬肌間隙入路組，其中行後正中入路取齣患者30例，行椎徬肌間隙入路取齣患者33例。記錄併比較兩組手術時間、手術齣血量、術後24 h疼痛視覺模擬數字法評分（ VAS）及住院時間，併行組間比較。結果：所有患者椎弓根螺釘繫統均完整拆除，無明顯併髮癥。椎徬肌間隙入路組手術時間（38.1±5.8）min，術中齣血量（52.4±7.8）mL，術後24 h及72 h患者腰揹部VAS評分為（2.5±0.3）分和（0.6±0.1）分，住院時間（4.0±0.5）d。後正中入路組手術時間（76.0±8.8）min，手術齣血量（186.1±25.4）mL，術後24 h及72 h患者腰揹部VAS評分為（7.4±0.4）分和（2.4±0.2）分，住院時間（9.1±1.8）d。兩組手術時間、手術齣血量、腰揹部VAS 評分及住院時間比較，差異有統計學意義（P ﹤0.05），椎徬肌間隙入路組優于後正中入路組。結論：經椎徬肌間隙入路取齣胸腰椎椎弓根螺釘內固定繫統有減少手術時間、術後引流量明顯減少、創傷小、齣血少、疼痛輕、恢複快及住院時間短等優點，是一種安全和損傷較小的術式。
목적：탐토흉요추추방기간극입로재흉요추추궁근라정계통취출술중적응용。방법：선택2007년1월-2013년8월63례흉요추골절후로내고정술후취출추궁근라정계통적환자，수궤분위후정중입로조화추방기간극입로조，기중행후정중입로취출환자30례，행추방기간극입로취출환자33례。기록병비교량조수술시간、수술출혈량、술후24 h동통시각모의수자법평분（ VAS）급주원시간，병행조간비교。결과：소유환자추궁근라정계통균완정탁제，무명현병발증。추방기간극입로조수술시간（38.1±5.8）min，술중출혈량（52.4±7.8）mL，술후24 h급72 h환자요배부VAS평분위（2.5±0.3）분화（0.6±0.1）분，주원시간（4.0±0.5）d。후정중입로조수술시간（76.0±8.8）min，수술출혈량（186.1±25.4）mL，술후24 h급72 h환자요배부VAS평분위（7.4±0.4）분화（2.4±0.2）분，주원시간（9.1±1.8）d。량조수술시간、수술출혈량、요배부VAS 평분급주원시간비교，차이유통계학의의（P ﹤0.05），추방기간극입로조우우후정중입로조。결론：경추방기간극입로취출흉요추추궁근라정내고정계통유감소수술시간、술후인류량명현감소、창상소、출혈소、동통경、회복쾌급주원시간단등우점，시일충안전화손상교소적술식。
Objective:To investigate the applications of paraspinal muscle approach in removing pedicle screw fixation. Methods:Clinical materials of 63 patients who had pedicle screw removing,were collected from January 2007 to August 2013. Paraspinal muscles approach group included 33 patients who received operations with paraspinal muscles approach. Convention-al posterior midline approach group included 30 patients who received operations with conventional posterior midline approach. Mean-operative time,mean-blood loss,postoperative 24 h visual analog pain scale in digital scale( VAS)and hospital stays were compared between two group. Results:All patients were complete removal of pedicle screw system,no significant compli-cations. In paraspinal muscles approach group,mean operative time was(38. 1 ± 5. 8)min;mean blood loss was(52. 4 ± 7. 8) mL;24 h VAS scale and 72 h VAS scale were(2. 5 ± 0. 3)score and(0. 6 ± 0. 1)score,hospital stays was(4. 0 ± 0. 5)d. In conventional posterior midline approach group ,mean operative time was( 7 6 . 0 ± 8 . 8 )min;mean blood loss was( 1 8 6 . 1 ± 25 . 4 )mL;2 4 h VAS scale and 7 2 h VAS scale were( 7 . 4 ± 0 . 4 )score and( 2 . 4 ± 0 . 2 )score ,hospital stays was( 9 . 1 ± 1. 8)d. There were significant differences in mean operation time,mean blood loss,postoperative 24 h VAS and hospital stays between two groups(P﹤0. 05). Paraspinal muscles approach group was better than conventional posterior midline approach group. Conclusion:Paraspinal muscleapproach for removing pedical screw fixation shows less mean operation time,less bleed-ing. It provides a safe,effective,minimally invasive surgical option.
