应用翼状工作通道经椎旁肌间隙入路治疗胸腰椎骨折疗效分析
응용익상공작통도경추방기간극입로치료흉요추골절료효분석
Paraspinal muscle approach with winglike working channel in the treatment of thoracic and lumbar spine fracture
  • 万方数据
    中华外科杂志 중화외과잡지
    CHINESE JOURNAL OF SURGERY
    2015年 4期 294-299 ,共6页

    祁磊%李牧%司海朋%张帅%姜云鹏%薛敬松

    기뢰%리목%사해붕%장수%강운붕%설경송

    胸椎%腰椎%脊柱骨折%骨折固定术 胸椎%腰椎%脊柱骨摺%骨摺固定術
    흉추%요추%척주골절%골절고정술
    Thoracic vertebrae%Lumbar vertebrae%Spinal fractures%Fracture fixation
    目的 探讨应用翼状工作通道经椎旁肌间隙入路治疗胸腰椎骨折的临床疗效和影像学结果.方法 2010年10月至2012年8月有51例无神经症状的胸腰椎骨折患者在山东大学齐鲁医院骨科接受手术治疗,其中通过翼状工作通道经椎旁肌间隙入路治疗26例(翼状工作通道组),传统手术入路治疗25例(传统手术入路组).两组患者的骨折均为伤后2周内的新鲜骨折,无明显神经症状,椎管内占位≤1/3椎管矢状径,受伤椎体压缩≤2/3.排除病理性骨折、严重骨质疏松症的患者.对两组病例术前及术后视觉模拟评分(VAS)和影像学参数进行配对样本和独立样本t检验,对分类资料进行x2检验,对非正态分布参数进行Mann-Whitney U检验和Wilcoxon配对检验.结果 翼状工作通道组与传统手术入路组术中出血量分别为(91.5±36.6) ml和(209.2±38.3)ml(t=-11.216,P=0.000),术后引流量分别为(13.7±4.4) ml和(162.3±56.6)ml(t=-13.352,P=0.000),术后卧床时间分别为(87.3±11.5)h和(118.4±20.4)h(t=-6.727,P=0.000),术后3d背痛VAS分别为5.5±1.0和6.4±0.8(t=-3.304,P=0.002),末次随访背痛VAS分别为1.0(1.0)和2.0(1.0)(U=191.0,P=0.008),两组之间差异均有统计学意义.而两组病例手术时间分别为(109.0±29.7)min和(119.2±26.8)min,差异无统计学意义(t=-1.283,P=0.206).按改良Macnab疗效评定标准,两组病例对比差异无统计学意义(x2=0.513,P=0.774).两组病例术前伤椎椎体前缘高度百分比分别为(57.2±11.8)％和(55.2±10.9)％,术后1周分别为(95.2±8.3)％和(95.3±5.8)％,末次随访时分别为(92.9±6.7)％和(92.1±5.6)％,两组病例伤椎椎体前缘高度百分比在术前(t=0.685,P=0.496)、术后1周(t=-0.068,P=0.946)和末次随访时(t=0.505,P=0.615)差异均无统计学意义.两组病例矢状面后凸Cobb角术前分别为21.0°(12.5 °)和23.0°(12.0°),术后1周分别为3.0°(5.5°)和4.0°(4.5°),末次随访时分别为4.0°(5.5°)和6.0°(6.0°),两组病例矢状面后凸Cobb角在术前(U=316.0,P=0.544)、术后1周(U=342.5,P=0.893)和末次随访时(U =328.5,P=0.701)差异均无统计学意义.结论 通过翼状工作通道经椎旁肌间隙入路治疗胸腰椎骨折,能够取得良好的临床疗效和影像学效果.
    목적 탐토응용익상공작통도경추방기간극입로치료흉요추골절적림상료효화영상학결과.방법 2010년10월지2012년8월유51례무신경증상적흉요추골절환자재산동대학제로의원골과접수수술치료,기중통과익상공작통도경추방기간극입로치료26례(익상공작통도조),전통수술입로치료25례(전통수술입로조).량조환자적골절균위상후2주내적신선골절,무명현신경증상,추관내점위≤1/3추관시상경,수상추체압축≤2/3.배제병이성골절、엄중골질소송증적환자.대량조병례술전급술후시각모의평분(VAS)화영상학삼수진행배대양본화독립양본t검험,대분류자료진행x2검험,대비정태분포삼수진행Mann-Whitney U검험화Wilcoxon배대검험.결과 익상공작통도조여전통수술입로조술중출혈량분별위(91.5±36.6) ml화(209.2±38.3)ml(t=-11.216,P=0.000),술후인류량분별위(13.7±4.4) ml화(162.3±56.6)ml(t=-13.352,P=0.000),술후와상시간분별위(87.3±11.5)h화(118.4±20.4)h(t=-6.727,P=0.000),술후3d배통VAS분별위5.5±1.0화6.4±0.8(t=-3.304,P=0.002),말차수방배통VAS분별위1.0(1.0)화2.0(1.0)(U=191.0,P=0.008),량조지간차이균유통계학의의.이량조병례수술시간분별위(109.0±29.7)min화(119.2±26.8)min,차이무통계학의의(t=-1.283,P=0.206).안개량Macnab료효평정표준,량조병례대비차이무통계학의의(x2=0.513,P=0.774).량조병례술전상추추체전연고도백분비분별위(57.2±11.8)％화(55.2±10.9)％,술후1주분별위(95.2±8.3)％화(95.3±5.8)％,말차수방시분별위(92.9±6.7)％화(92.1±5.6)％,량조병례상추추체전연고도백분비재술전(t=0.685,P=0.496)、술후1주(t=-0.068,P=0.946)화말차수방시(t=0.505,P=0.615)차이균무통계학의의.량조병례시상면후철Cobb각술전분별위21.0°(12.5 °)화23.0°(12.0°),술후1주분별위3.0°(5.5°)화4.0°(4.5°),말차수방시분별위4.0°(5.5°)화6.0°(6.0°),량조병례시상면후철Cobb각재술전(U=316.0,P=0.544)、술후1주(U=342.5,P=0.893)화말차수방시(U =328.5,P=0.701)차이균무통계학의의.결론 통과익상공작통도경추방기간극입로치료흉요추골절,능구취득량호적림상료효화영상학효과.
    Objective To evaluate the clinical and radiological efficacy of paraspinal muscle approach with winglike working channel in the treatment of thoracic and lumbar spine fracture.Methods From October 2010 to August 2012,a total of 51 patients with thoracic and lumbar spine fractures without neurological symptoms were enrolled in the study,including 32 males and 19 females.All patients were divided into two groups:26 patients were treated through posterior paraspinal muscle approach with winglike working channel,and 25 patients were treated through traditional posterior approach.In all patients,the interval between injury and operation was less than two weeks;the vertebral canal blocked area was less than 1/3 in sagittal diameter; the compression of the fractured vertebra height was less than 2/3.And the patients with pathological fracture and severe osteoporosis were excluded.The perioperative index including operative blood loss,draining loss,operative time,postoperative bed time were recorded.The clinical results were evaluated by visual analogue scale (VAS) for back pain preoperatively,at 3 days,3 months,the last follow-up postoperatively and modified Macnab criteria at the last follow-up.The radiological results were evaluated by sagittal Cobb angle and the anterior height of the fractured vertebra.The data of two groups were compared statistically with paired and independent t test,x2 test,Mann-Whitney U test and Wilcoxon test.Results All patients were followed up with average of 16.6 months.In the two groups,the operative blood loss was respectively (91.5 ± 36.6) ml and (209.2 ± 38.3) ml (t =-11.216,P =0.000),draining loss was (13.7 ± 4.4) ml and (162.3 ± 56.6) ml (t =-13.352,P =0.000),postoperative bed time was (87.3 ± ll.5)hours and (118.4 ± 20.4) hours (t =-6.727,P =0.000),VAS for back pain at 3 days postoperatively was 5.5 ± 1.0 and 6.4 ± 0.8 (t =-3.304,P =0.002),also VAS at the last follow-up was 1.0(1.0)and 2.0(1.0) (U =191.0,P =0.008).Data above showed significant differences between the two groups.No significant differences were found in operative time,(109.0 ± 29.7) min vs.(119.2 ± 26.8) min (t =-1.283,P =0.206),and modified Macnab criteria (x2 =0.513,P =0.774) between the two groups.The anterior height of the fractured vertebra preoperatively,at 1 week and the last follow-up postoperatively of the two groups were respectively (57.2 ± 11.8)％ and (55.2 ± 10.9)％ (t =0.685,P =0.496),(95.2±8.3)％ and (95.3 ±5.8％) (t =-0.068,P =0.946),(92.9 ±6.7)％ and (92.1 ± 5.6) ％ (t =0.505,P =0.615).The sagittal Cobb angles preoperatively,at 1 week and the last follow-up postoperatively of the two groups were respectively 21.0° (12.5°) and 23.0° (12.0°) (U =316.0,P =0.544),3.0°(5.5°) and 4.0° (4.5°) (U =342.5,P =0.893),4.0°(5.5°) and 6.0°(6.0°) (U =328.5,P =0.701).There were no significant differences of these radiological results between the two groups in the same time point.Conclusion The paraspinal muscle approach with winglike working channel in the treatment of thoracic and lumbar spine fracture is an efficient surgical option which can acquire satisfactory clinical and radiological results.
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