椎旁肌间隙入路结合伤椎置钉技术治疗胸腰段骨折的近期临床疗效评估

目的:讨论椎旁肌间隙入路结合伤椎置钉技术治疗胸腰段骨折的近期临床疗效。方法:选取2013年4月至2014年9月我院确诊的胸腰段骨折患者95例,应用椎旁肌间隙入路结合伤椎置钉技术治疗。分别在手术前、术后1个月、3个月、6个月、1年,采用视觉模拟评分法(VAS)、腰背痛日本骨科协会评分(JOA)对患者手术前后腰背疼痛进行评估,另外对手术前后伤椎前后缘高度比及胸腰段后凸畸形Cobb角进行测定分析。结果:患者术后的VAS评分、JOA评分随术后1个月、3个月、6个月、1年时间不断下降,且均低于手术前,差异均具有统计学意义(P0.05);术后患者不同时间点的伤椎前后缘高度比不断下降,且胸腰段后凸畸形Cobb角较术前均明显减小,差异均具有统计学意义(P0.05)。结论:采用椎旁肌间隙入路结合伤椎置钉技术治疗胸腰段骨折患者,可缓解其腰背疼痛,术后脊柱矫形效果明显,短期预后好,值得在临床上广泛应用。

Paravertebral Intermuscular Approach Combined with Pedicle Fixation at the Fractured Vertebra for Thoracolumbar Fractures

Objective:To discuss the short-term clinical effect of pedicle fixation at the fractured vertebra via paravertebral intermuscular approach for thoracolumbar fractures.Methods:A total of 95 patients with thoracolumbar fractures, who were treated in Third Hospital Affiliated of Hebei Medical University from April 2013 to September 2014, were selected. All the patients were treated with pedicle fixation at the fractured vertebra via paravertebral intermuscular approach. The waist and back pains of the patients were evaluated by visual analogue scale(VAS) and the Japanese Orthopaedic Association(JOA) score 1 month, 3 months, 6 months and 1 year before and after operation; The height ratio of the posterior margin to posterior margin of the injured vertebra and thoracolumbar kyphosis deformity Cobb angle were determined and analysed.Results:VAS scores and JOA scores gradually decreased during 1 month, 3 months, 6 months, and 1 year after operation, lower than before operation,the differences were statistically significant (P<0.05). The height ratio of the posterior margin to posterior margin of the injured vertebra at different time points gradually decreased, and the thoracolumbar kyphosis deformity Cobb angle after operation significantly decreased than before operation, the differences were statistically significant (P<0.05).Conclusion:Using pedicle fixation at the fractured vertebra via paravertebral intermuscular approach to treat the patients with thoracolumbar fractures can significantly relieve the waist and back pains, with obvious spine orthopedic effect and good short-termprognosis, which is worthy of clinical application.