CAJ | 학술논문

背景：短节段椎弓根钉技术修复胸腰椎骨折在临床应用广泛，研究表明经肌间隙入路出血少，创伤小，恢复快，采用后正中线旁双皮肤切口经肌间隙椎弓根螺钉置入内固定的优越性需进一步研究。目的：探讨后正中线旁双皮肤切口经椎旁肌间隙入路短节段椎弓根钉置入内固定修复胸腰椎骨折的临床疗效及Cobb’s角变化。方法：回顾性分析2010年9月至2012年6月收治的56例胸腰椎骨折患者的病历资料，男42例，女14例；年龄18-59岁，平均45岁。根据修复入路分为两组，传统后正中入路组25例，经椎旁肌间隙入路组31例。比较两组患者手术时间、术中出血量、内固定后引流量、内固定后开始下地时间、内固定后7d、1个月、6个月的腰背部目测类比评分、内固定前后和末次随访时损伤节段的后凸角。结果与结论：所有患者内固定后获得随访，经椎旁肌间隙入路组在手术时间、术中出血量、内固定后引流量、内固定后开始下地时间、内固定后7 d、1个月腰背部目测类比评分等方面均有显著优势(P <0.05)。两组内固定后Cobb’s角与同组治疗前比较，差异均有显著性意义(P<0.05)；两组间内固定后Cobb’s角比较差异无显著性意义(P>0.05)。提示后正中线旁双皮肤切口经肌间隙入路短节段椎弓根钉置入修复胸腰椎骨折，具有创伤小、出血少和恢复快等优点，操作简单，与开放手术修复胸腰椎骨折效果相近，能有效恢复椎体的解剖形态及重建脊柱稳定性，与宿主的生物相容性好。
배경：단절단추궁근정기술수복흉요추골절재림상응용엄범，연구표명경기간극입로출혈소，창상소，회복쾌，채용후정중선방쌍피부절구경기간극추궁근라정치입내고정적우월성수진일보연구。목적：탐토후정중선방쌍피부절구경추방기간극입로단절단추궁근정치입내고정수복흉요추골절적림상료효급Cobb’s각변화。방법：회고성분석2010년9월지2012년6월수치적56례흉요추골절환자적병력자료，남42례，녀14례；년령18-59세，평균45세。근거수복입로분위량조，전통후정중입로조25례，경추방기간극입로조31례。비교량조환자수술시간、술중출혈량、내고정후인류량、내고정후개시하지시간、내고정후7d、1개월、6개월적요배부목측류비평분、내고정전후화말차수방시손상절단적후철각。결과여결론：소유환자내고정후획득수방，경추방기간극입로조재수술시간、술중출혈량、내고정후인류량、내고정후개시하지시간、내고정후7 d、1개월요배부목측류비평분등방면균유현저우세(P <0.05)。량조내고정후Cobb’s각여동조치료전비교，차이균유현저성의의(P<0.05)；량조간내고정후Cobb’s각비교차이무현저성의의(P>0.05)。제시후정중선방쌍피부절구경기간극입로단절단추궁근정치입수복흉요추골절，구유창상소、출혈소화회복쾌등우점，조작간단，여개방수술수복흉요추골절효과상근，능유효회복추체적해부형태급중건척주은정성，여숙주적생물상용성호。
BACKGROUND:Short-segment pedicle screw technology has been extensively used in the treatment and repair of thoracolumbar burst fractures. The technique of operative treatment through the paraspinal muscle approach has advantages such as less trauma and bleeding, and rapid recovery. However, it requires further investigations to verify the superiority of the paraspinal muscle approach of two lateral incisions near the posterior median line. OBJECTIVE:To evaluate the clinical efficacy and Cobb’s angle of short-segment pedicle screw fixation through paraspinal muscle approach of two lateral incisions near the posterior median line in the treatment of thoracic and lumbar fractures. METHODS:From September 2010 to June 2012, 56 patients with thoracic and lumbar fractures were included in the retrospective study, including 42 males and14 females, with an average of 45 years (range 18-59 years). According to the surgical approach, patients were divided into two groups, traditional approach (n=25) and paraspinal muscle approach (n=31). The operative time, intraoperative blood loss, postoperative drainage and postoperative ambulant time in the two groups were observed and compared. The visual analog scale scores at 7 days, 1 month and 6 months postoperatively were recorded. The Cobb’s angles of suffered vertebra were measured preoperatively and at 7 days and 6 months postoperatively. RESULTS AND CONCLUSION:Al patients were fol owed up after internal fixation. The paraspinal muscle approach was superior to traditional approach in the operation time, intraoperative blood loss, postoperative drainage and postoperative ambulant time, and visual analog scale scores at 7 days and 1 month postoperatively (P<0.05). There was no significant difference between the preoperative and postoperative Cobb’s angle in the two groups (P>0.05). The short-segment pedicle screw fixation through paraspinal muscle approach of two lateral incisions near the posterior median line in the treatment of thoracic and lumbar fractures, is an effective and minimal y invasive treatment, with less trauma, less bleeding, rapid recovery, and simple operations. Similar to open surgery, this treatment can recover the anatomical morphology and reconstruct spinal stability, and had good biocompatibility to the host.