中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2014年
23期
4177-4181
,共5页
赵明伟%杨素珉%周伟东%马广仁%王军
趙明偉%楊素珉%週偉東%馬廣仁%王軍
조명위%양소민%주위동%마엄인%왕군
结核,脊柱%外科手术%多裂肌%Wiltse%小切口
結覈,脊柱%外科手術%多裂肌%Wiltse%小切口
결핵,척주%외과수술%다렬기%Wiltse%소절구
Tuberculosis,spinal%Surgical procedures,operative%Multifidus%Wiltse approach%Small incision
目的：比较棘突旁小切口经多裂肌间隙入路与后正中入路在腰椎结核后路手术中的差异。方法选取2009年1月至2013年3月收治的腰椎结核患者90例，进行随机分组，治疗组45例：小切口多裂肌间隙入路；对照组45例：后正中入路。对两组的手术时间、手术的出血量、手术前后视觉模拟评分法（VAS）评分、切口引流情况进行对比。内固定取出术后6个月随访腰椎MR检查。组间数据统计分析采用t检验和χ2检验。结果治疗组与对照组在手术时间[（93±12.40） min vs.（150±16.90）min，t＝18.381，P＜0.01]、出血量[（121±39.62）ml vs.（340±47.83）ml， t＝23.897，P＜0.01]、切口引流量[（56±14.2）ml vs.（131±11.5）ml，t＝27.533，P＜0.01]及引流管拔除时间[（39±8.5）h vs.（51±11.1）h，t＝5.758，P＜0.01]差异均有统计学意义。术后VAS评分治疗组与对照组在1周（3.28±1.02vs.4.49±1.13，t＝5.972，P＜0.01）、1个月（2.16±0.81 vs.3.54±0.88，t＝7.740，P＜0.01）、3个月（1.03±0.75vs.2.42±0.64，t＝9.457，P＜0.01）差异均存在统计学意义。内固定取出术后6个月MR检查随访结果显示，治疗组与对照组手术区域多裂肌间隙出现纤维化及高密度区的例数分别为7例和28例，差异有统计学意义（χ2＝20.618，P＜0.01）。结论在腰椎结核手术中棘突旁小切口多裂肌间隙入路足够进行椎弓根螺钉置入，入路创伤小，愈合满意，患者疼痛较轻，优于后正中入路，值得临床推广。
目的：比較棘突徬小切口經多裂肌間隙入路與後正中入路在腰椎結覈後路手術中的差異。方法選取2009年1月至2013年3月收治的腰椎結覈患者90例，進行隨機分組，治療組45例：小切口多裂肌間隙入路；對照組45例：後正中入路。對兩組的手術時間、手術的齣血量、手術前後視覺模擬評分法（VAS）評分、切口引流情況進行對比。內固定取齣術後6箇月隨訪腰椎MR檢查。組間數據統計分析採用t檢驗和χ2檢驗。結果治療組與對照組在手術時間[（93±12.40） min vs.（150±16.90）min，t＝18.381，P＜0.01]、齣血量[（121±39.62）ml vs.（340±47.83）ml， t＝23.897，P＜0.01]、切口引流量[（56±14.2）ml vs.（131±11.5）ml，t＝27.533，P＜0.01]及引流管拔除時間[（39±8.5）h vs.（51±11.1）h，t＝5.758，P＜0.01]差異均有統計學意義。術後VAS評分治療組與對照組在1週（3.28±1.02vs.4.49±1.13，t＝5.972，P＜0.01）、1箇月（2.16±0.81 vs.3.54±0.88，t＝7.740，P＜0.01）、3箇月（1.03±0.75vs.2.42±0.64，t＝9.457，P＜0.01）差異均存在統計學意義。內固定取齣術後6箇月MR檢查隨訪結果顯示，治療組與對照組手術區域多裂肌間隙齣現纖維化及高密度區的例數分彆為7例和28例，差異有統計學意義（χ2＝20.618，P＜0.01）。結論在腰椎結覈手術中棘突徬小切口多裂肌間隙入路足夠進行椎弓根螺釘置入，入路創傷小，愈閤滿意，患者疼痛較輕，優于後正中入路，值得臨床推廣。
목적：비교극돌방소절구경다렬기간극입로여후정중입로재요추결핵후로수술중적차이。방법선취2009년1월지2013년3월수치적요추결핵환자90례，진행수궤분조，치료조45례：소절구다렬기간극입로；대조조45례：후정중입로。대량조적수술시간、수술적출혈량、수술전후시각모의평분법（VAS）평분、절구인류정황진행대비。내고정취출술후6개월수방요추MR검사。조간수거통계분석채용t검험화χ2검험。결과치료조여대조조재수술시간[（93±12.40） min vs.（150±16.90）min，t＝18.381，P＜0.01]、출혈량[（121±39.62）ml vs.（340±47.83）ml， t＝23.897，P＜0.01]、절구인류량[（56±14.2）ml vs.（131±11.5）ml，t＝27.533，P＜0.01]급인류관발제시간[（39±8.5）h vs.（51±11.1）h，t＝5.758，P＜0.01]차이균유통계학의의。술후VAS평분치료조여대조조재1주（3.28±1.02vs.4.49±1.13，t＝5.972，P＜0.01）、1개월（2.16±0.81 vs.3.54±0.88，t＝7.740，P＜0.01）、3개월（1.03±0.75vs.2.42±0.64，t＝9.457，P＜0.01）차이균존재통계학의의。내고정취출술후6개월MR검사수방결과현시，치료조여대조조수술구역다렬기간극출현섬유화급고밀도구적례수분별위7례화28례，차이유통계학의의（χ2＝20.618，P＜0.01）。결론재요추결핵수술중극돌방소절구다렬기간극입로족구진행추궁근라정치입，입로창상소，유합만의，환자동통교경，우우후정중입로，치득림상추엄。
Objective To compare the differences of minimally invasive small incision next to positive multifidus muscle gap approach and posterior midline approach in lumbar tuberculosis posterior surgery.Methods 90 cases of lumbar tuberculosis in our surgical department from January 2009 to March 2013 were randomly divided into two groups, multifidus muscle gap approach with small incision on the sides of spinous process group (observation group) and posterior midline approach group (control group), the index (operation time, blood loss, visual analogue scale, wound hematoma) were compared before and after surgery, follow-up of MR imaging in the lumbar spine were done in 6 months after remove internal fixation, compared using thettest or chi-square test between groups.Results Treatment and control groups were statistically significant in operative time, (93±12.40)minvs. (150±16.90)min (t=18.381,P<0.01), bleeding, (121±39.62)ml vs. (340±47.83)ml (t=23.897,P<0.01), cut the lead flow, (56±14.2)ml vs. (131±11.5)ml (t=27.533,P<0.01) and the drainage tube removal time, (39±8.5)h vs. (51±11.1)h (t=5.758,P<0.01). Postoperative VAS scores of treatment and control groups in one week were 3.28±1.02 vs.4.49±1.13 (t=5.972,P<0.01); one month: 2.16±0.81 vs.3.54±0.88 (t=7.740,P<0.01); 3 months: 1.03±0.75 vs.2.42±0.64 (t=9.457,P<0.01), there is a statistically significant difference. The number of cases of fibrosis and high-density zones in the surgical field gap multifidus muscle appearing in the follow-up MR imaging (6 months after remove internal fixation) in the treatment group and the control group were 7 cases and 28 cases, the difference was statistically significant (χ2=20.618,P<0.01). Conclusion Multifidus muscle gap approach with small incision on the sides of spinous process in posterior surgery in lumbar tuberculosis is sufficient for pedicle screw implantation, and the healing of small incision is satisfied, patients feel less pain, it is better than posterior midline approach and deserve the clinical expansion.
