[1]吴永光,全炜琨,胡　玄,等.经肌间隙椎弓根螺钉固定术结合椎体内植骨术治疗胸腰椎骨折的疗效与安全性评价[J].新乡医学院学报,2019,36(11):1040-1043.[doi:10.7683/xxyxyxb.2019.11.008]
　WU Yong-guang,QUAN Wei-kun,HU Xuan,et al.Evaluation of the effect and safety of intermuscular approach pedicle screw fixation combined with intravertebral bone grafting in the treatment of thoracolumbar fractures[J].Journal of Xinxiang Medical University,2019,36(11):1040-1043.[doi:10.7683/xxyxyxb.2019.11.008]
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经肌间隙椎弓根螺钉固定术结合椎体内植骨术治疗胸腰椎骨折的疗效与安全性评价
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
36
期数:
2019年11
页码:
1040-1043
栏目:
临床研究
出版日期:
2019-11-05

文章信息/Info

Title:
Evaluation of the effect and safety of intermuscular approach pedicle screw fixation combined with intravertebral bone grafting in the treatment of thoracolumbar fractures
作者:
吴永光1; 全炜琨1; 胡　玄1; 曾　恒2
（1.武汉市蔡甸区人民医院骨科 华中科技大学协和江北医院骨科，湖北　武汉　430100；2.华中科技大学同济医学院附属同济医院脊柱外科，湖北　武汉　430030）
Author(s):
WU Yong-guang1; QUAN Wei-kun1; HU Xuan1; ZENG Heng2
(1.Department of Osteology，Caidian District People′s Hospital of Wuhan，Xiehe Jiangbei Hospital of Huazhong University of Science and Technology，Wuhan 430100，Hubei Province，China；2.Department of Spine Surgery，Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology，Wuhan 430030，Hubei Province，China)
关键词:
胸腰椎骨折; 经肌间隙入路; 椎体内植骨术
Keywords:
thoracolumbar fractures; intermuscular approach; intravertebral bone grafting
分类号:
R681.5+3
DOI:
10.7683/xxyxyxb.2019.11.008
文献标志码:
A
摘要:
目的　探讨经肌间隙椎弓根螺钉固定术结合椎体内植骨术治疗胸腰椎骨折的临床效果及安全性。方法　选择2018年1月~12月华中科技大学协和江北医院收治的胸腰椎骨折患者60例，所有患者行椎弓根螺钉固定术结合椎体内植骨术，根据手术入路分为观察组和对照组，每组30例；观察组患者采用经肌间隙入路，对照组患者采用传统背部正中入路。比较2组患者手术时间、术中出血量、术后引流量及住院时间；分别于术前及术后第2、4、8 天检测患者血清肌酸激酶水平；分别于患者术前和术后即刻、3 个月测量伤椎椎体前缘高度及后凸 Cobb 角；分别于术前及术后24 h、3个月采用视觉模拟评分法（VAS）评估患者腰背痛情况，并观察2组患者并发症发生情况。结果　观察组患者的手术时间、住院时间显著短于对照组，术中出血量和术后引流量显著少于对照组（P<0.05）。术前及术后第8天2组患者血清肌酸激酶水平比较差异无统计学意义（P>0.05）；术后第2、4天，观察组患者血清肌酸激酶水平低于对照组（P<0.05）。2组患者术后第2、4天血清肌酸激酶水平显著高于术前，术后第8天血清肌酸激酶水平显著低于术前及术后第2、4天（P<0.05）。2组患者术前伤椎后凸Cobb角、椎体前缘高度比较差异无统计学意义（P>0.05）；2组患者术后即刻及3个月伤椎后凸Cobb角小于术前，椎体前缘高度大于术前（P<0.05）；术后即刻及3个月2组患者伤椎后凸Cobb角及椎体前缘高度较差异均无统计学意义（P>0.05）。2组患者术前VAS评分比较差异无统计学意义（P>0.05）；术后24 h及3个月时观察组患者VAS评分显著低于对照组（P<0.05）；2组患者术后24 h及3个月时VAS评分显著低于术前（P<0.05），术后3个月时VAS评分显著低于术后24 h（P<0.05）。观察组和对照组患者并发症发生率分别为6.7%（2/30）、23.3%（7/30），观察组患者并发症发生率低于对照组（χ2=3.726，P<0.05）。结论　经肌间隙入路结合椎体内植骨治疗胸腰椎骨折可以有效恢复椎体高度，纠正脊柱Cobb角，维持脊柱稳定性，且具有手术时间短、术中出血量少、椎旁肌损伤轻、并发症发生率低等优势。
Abstract:
Objective　To investigate the clinical effect and safety of intermuscular approach pedicle screw fixation combined with intravertebral bone grafting in the treatment of thoracolumbar fractures.Methods　Sixty patients with thoracolumbar fracture admitted to Xiehe Jiangbei Hospital of Huazhong University of Science and Technology from January 2018 to December 2018 were selected as the study objects.All patients were treated with pedicle screw fixation combined with intravertebral bone grafting.The patients were divided into observation group and control group according to the operation approach，with 30 cases in each group.The patients in the observation group were operated through the intermuscular approach，while the patients in the control group were operated through the posterior median approach.The operation time，intraoperative bleeding volume，postoperative drainage volume and hospitalization time were compared between the two groups.The level of serum creatine kinase was measured before operation and 2,4,8 days after operation.The anterior height and kyphotic Cobb angle of the injured vertebra were measured before and instant and three months after operation.The lumbodorsal pain of patients was evaluated by visual analogue scale (VAS) before and 24 hours and three months after operation.The complications of patients in the two groups were observed.Results　The operation time and hospitalization time in the observation group were significantly shorter than those in the control group，and the intraoperative bleeding volume and postoperative drainage volume in the operation group were significantly less than those in the control group (P<0.05).There was no significant difference in serum creatine kinase level between the two groups before and 8 days after operation (P>0.05).The serum creatine kinase level in the observation group was lower than that in the control group on the 2nd and 4th day after operation (P<0.05).The level of serum creatine kinase on the 2nd and 4th day after operation was significantly higher than that before operation，and it on the 8th day after operation was significantly lower than that on the 2nd and 4th day after operation (P<0.05).There was no significant difference in kyphotic Cobb angle and anterior height of the injured vertebra between the two groups (P>0.05).In the two groups，the kyphotic Cobb angle of the injured vertebra at instant and three months after operation was smaller than that before operation，and the anterior height of the injured vertebra was higher than that before operation (P<0.05).There was no significant difference in kyphotic Cobb angle and anterior height of the injured vertebra between the two groups at instant and three months after operation (P>0.05).There was no significant difference in VAS score between the two groups before operation(P>0.05).The VAS score in the observation group was significantly lower than that in the control group at 24 hours and three months after operation (P<0.05).The VAS score at 24 hours and three months after operation was significantly lower than that before operation in the two groups (P<0.05).The VAS score at three months after operation was significantly lower than that at 24 hours after operation in the two groups (P<0.05).The incidence of complications in the observation group and the control group was 6.7% (2/30) and 23.3% (7/30)，respectively.The incidence of complications in the observation group was lower than that in the control group (χ2=3.726，P<0.05).Conclusion　Intermuscular approach pedicle screw fixation combined with intravertebral bone grafting in the treatment of thoracolumbar fractures can effectively restore the anterior height of the injured vertebra，correct the Cobb angle of the spine，maintain the stability of the spine，and has the advantages of short operation time，less intraoperative bleeding，light paravertebral muscle injury and low incidence of complications.

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更新日期/Last Update: 2019-11-05