Department of Orthopaedics, Liaoyang Central Hospital, Liaoning, China.
Orthop Surg. 2009 Aug;1(3):184-8. doi: 10.1111/j.1757-7861.2009.00032.x.
To investigate the methods for, and clinical outcome of, the operative treatment of thoracolumbar fractures through an approach via the paravertebral muscle (PVM).
From June 2005 to August 2006, 62 patients, comprising 48 men and 14 women with an average age of 45.2 years (range, 21-58) with thoracolumbar fractures without neurological involvement underwent surgical treatment. Twenty-one fractures were located at T12, 24 at L1 and 17 at L2. The study comprised 15 compression and 47 burst fractures with an intact posterior column. Thirty-four cases were selected randomly to undergo surgery through the above approach, while the other 28 cases underwent the traditional procedure. After making a posterior midline incision, which not only facilitates insertion of pedicle screws and fusion of the graft bone at facet joints, but spares the attachment of PVM, the interval between the longissimus and multifidus muscles was undermined. Drainage was not routinely needed and the patients became ambulant with a brace earlier post-operatively.
The new approach had statistically significant advantages (P < 0.005) over the traditional one in regard to blood loss, drainage, duration of recumbency and visual analogue scale (VAS), although the time required was almost the same for the two procedures. Till August 2007, 56 patients were successfully followed up for 12 to 26 months (mean, 18.6) and bone fusion was identified in all cases. Neither reduction loss nor loosening or breakage of the fixation occurred.
The technique of operating through an approach between the PVM is recommended for thoracolumbar fractures because it is much less invasive, can reduce blood loss and accelerates rehabilitation.
探讨经椎旁肌间隙入路治疗胸腰椎骨折的方法和临床疗效。
2005 年 6 月至 2006 年 8 月，采用经椎旁肌间隙入路治疗无神经损伤的胸腰椎骨折患者 62 例，男 48 例，女 14 例；年龄 21～58 岁，平均 45.2 岁。T12 骨折 21 例，L1 骨折 24 例，L2 骨折 17 例。骨折类型：压缩骨折 15 例，爆裂骨折 47 例，后柱完整。34 例患者采用上述入路手术治疗（观察组），28 例患者采用传统后正中入路手术治疗（对照组）。两组患者均行后路切开复位内固定植骨融合术。术中后正中切口，不仅便于椎弓根螺钉置入和关节突植骨融合，而且可避免椎旁肌损伤。显露棘突和椎板后，沿多裂肌与最长肌间隙进入，剥离两侧肌肉附着点。术后常规引流，患者佩戴支具早期下地活动。
观察组术中出血量、引流量、卧床时间、视觉模拟评分（VAS）均显著优于对照组（P＜0.005），但手术时间两组比较差异无统计学意义（P＞0.05）。至 2007 年 8 月，56 例患者获得随访，时间 12～26 个月，平均 18.6 个月。所有患者骨折均愈合，无复位丢失、内固定松动或断裂。
经椎旁肌间隙入路治疗胸腰椎骨折创伤小、出血量少，可减少术后卧床时间，有利于患者早期康复，值得临床推广应用。
