CAJ | 학술논문

背景：临床修复脊柱胸腰段骨折的过程中可以选择不同的修复入路，其中传统后正中入路会对患者造成较大的创伤，容易导致一定概率不良后果的出现。目的：对比椎弓根螺钉经传统后正中入路与椎旁肌间隙入路置入内固定修复脊柱胸腰段骨折的效果及生物相容性。方法：回顾性分析陕西省核工业215医院2012年12月至2013年12月收治的53例脊柱胸腰段骨折患者的临床资料，按照修复入路分为2组，对照组27例实施传统后正中入路椎弓根螺钉置入内固定，观察组26例实施椎旁肌间隙入路微创椎弓根螺钉置入内固定。修复后随访12个月，观察两组患者的影像学检查结果、疼痛目测类比评分及围手术期相关指标，并进行比较。结果与结论：分别在修复前、修复后即刻以及末次随访对两组患者进行影像学检查，可得两组经过不同的治疗，均获得良好的椎体前缘高度和后凸角矫正效果，但组间比较差异无显著性意义(均P >0.05)，表明两组的椎体前缘高度和后凸角矫正效果相当。修复后24 h，3 d和末次随访观察组患者的疼痛目测类比评分均显著低于对照组(均P <0.05)。对两组患者的围修复期相关指标进行分析，可得观察组在术中出血量、引流以及修复后卧床时间等方面均较对照组存在显著优势(均P <0.05)。表明较之传统后正中入路，利用椎旁肌间隙入路微创椎弓根螺钉置入固定脊柱胸腰段骨折可以获得更好的修复效果及生物相容性。
배경：림상수복척주흉요단골절적과정중가이선택불동적수복입로，기중전통후정중입로회대환자조성교대적창상，용역도치일정개솔불량후과적출현。목적：대비추궁근라정경전통후정중입로여추방기간극입로치입내고정수복척주흉요단골절적효과급생물상용성。방법：회고성분석합서성핵공업215의원2012년12월지2013년12월수치적53례척주흉요단골절환자적림상자료，안조수복입로분위2조，대조조27례실시전통후정중입로추궁근라정치입내고정，관찰조26례실시추방기간극입로미창추궁근라정치입내고정。수복후수방12개월，관찰량조환자적영상학검사결과、동통목측류비평분급위수술기상관지표，병진행비교。결과여결론：분별재수복전、수복후즉각이급말차수방대량조환자진행영상학검사，가득량조경과불동적치료，균획득량호적추체전연고도화후철각교정효과，단조간비교차이무현저성의의(균P >0.05)，표명량조적추체전연고도화후철각교정효과상당。수복후24 h，3 d화말차수방관찰조환자적동통목측류비평분균현저저우대조조(균P <0.05)。대량조환자적위수복기상관지표진행분석，가득관찰조재술중출혈량、인류이급수복후와상시간등방면균교대조조존재현저우세(균P <0.05)。표명교지전통후정중입로，이용추방기간극입로미창추궁근라정치입고정척주흉요단골절가이획득경호적수복효과급생물상용성。
BACKGROUND:Different operation approaches can be selected during the repair of thoracolumbar fractures. Traditional posterior median approach wil cause great wound on patients, and easily induces some adverse consequences. OBJECTIVE: To compare the effects and biocompatibility of conventional posterior median approach and paraspinal approach fixation for treatment of thoracolumbar fractures. METHODS: A retrospective analysis was performed on clinical data of 53 cases of thoracolumbar fracture in the Shaanxi Province Nuclear Industry 215 Hospital from December 2012 to December 2013. They were divided into two groups according to approach method. The control group (n=27) received pedicle screw placement fixation through conventional posterior median approach. The observation group (n=26) underwent pedicle screw placement fixation through paraspinal muscle approach. After repair, they were folowed up for 12 months. Imaging results, pain score and perioperative relevant indexes were observed and compared in both groups. RESULTS AND CONCLUSION: Imaging examination was conducted before repair, immediately after repair and during final folow-up in both groups. The height of vertebral anterior border and kyphosis correction effect were good after different therapies in both group, but no significant difference was detectable between the two groups (al P > 0.05). These findings suggest that height of vertebral anterior border and kyphosis correction effect were identical between the two groups. Pain visual analog scale score was significantly lower in the observation group than in the control group at 24 hours and 3 days after repair and during final folow-up (al P < 0.05). Perioperative relevant indexes were analyzed in both groups. Intraoperative bleeding amount, drainage and bed time after repair were observed in the observation group, which showed significant advantages as compared with the control group (al P < 0.05). These results confirmed that compared with the traditional posterior median approach surgery, minimaly invasive pedicle screw placement through paraspinal muscle approach for thoracolumbar fractures can obtain better repair effects and biocompatibility.