Wang Ren-Yan, Hua Yong-Jun, Chen Jin-Hong, Chai Jun-Lei, Shao Li-Fang, Zhao Jian-Feng
Hospital of Orthopaedics and Traumatology of TCM of Fuyang City, Fuyang 311400, Zhejiang, China.
Zhongguo Gu Shang. 2012 Jan;25(1):42-6.
To compare the clinical effect of thoracolumbar fractures between single-segment pedicle screw fixation approach for the gap of paravertebral muscles and double-segment pedicle screw fixation approach for the stripping of paravertebral muscles.
From September 2008 to January 2010, 65 patients with incomplete compressed thoracolumbar fractures or burst thoracolumbar fractures with unilateral endplate injury were randomly divided into two groups. Thirty patients were treated with single-segment pedicle screw fixation through the gap of paravertebral muscles (treatment group). Thirty-five patients were treated with double-segment pedicle screw fixation through the stripping of the paravertebral muscles (control group). All the internal fixations were taken out during 10-12 months after operation. Operative time, perioperative blood loss volume and postoperative drainage volume were compared between two groups. At final follow-up, the change of neurological ASIA grade were recorded; and postoperative 5 days and final follow-up, compared Denis classification of lumbar and back pain between two groups; and analyzed the sagittal index and compressibility of anterior border of vertebral body by X -ray lateral projection.
All patients were follow-up from 14 to 22 months with an average of 18.3 months. No postoperative infection, secondary spinal cord injury was found. One case of control group occurred internal fixation breakage at the 11th month after operation and other internal fixation no loosening. There was no significant difference in operative time, the recovery of neurological function between the two groups (P > 0.05). Perioperative blood loss volume and postoperative drainage volume of treatment group was less than that of control group (P < 0.01). And in Denis classification of lumbar and back pain, the treatment group recovered more quickly, and the residual pain of lumbar and back was less than that of control group (P < 0.01). Postoperative posterior salient and compression of anterior border of vertebral body improved in two groups (P < 0.01), there was no significant difference in degree of improvement between two groups (P > 0.05); but both loss existed at final follow-up (P < 0.01), there was no significant difference in loss of posterior salient between two groups (P > 0.05). In the treatment group, the loss of rectify of anterior border of vertebral body existed, but it was less than that of the control group.
In the premise of strict controlling surgery indications, the treatment of thoracolumbar fractures with single-segment pedicle screw fixation through the gap of paraspinal muscles, can effectively recover the height of vertebral body and rectify posterior salient, and reduce the fixed segment. Compared with the traditional operative method of double-segment pedicle screw fixation through the stripping of paraspinal muscle, it can obviously reduce the operation wound and the bleeding, lessen the pain of lumbar and back. And the recent clinical effect is satisfied.
比较经椎旁肌间隙单节段椎弓根螺钉固定与经椎旁肌剥离双节段椎弓根螺钉固定治疗胸腰椎骨折的临床疗效。
选取2008年9月至2010年1月收治的65例不完全压缩性胸腰椎骨折或单侧终板损伤的爆裂性胸腰椎骨折患者，随机分为两组。30例采用经椎旁肌间隙单节段椎弓根螺钉固定治疗（治疗组）。35例采用经椎旁肌剥离双节段椎弓根螺钉固定治疗（对照组）。术后10 - 12个月取出所有内固定物。比较两组手术时间、围手术期失血量及术后引流量。末次随访时，记录神经功能ASIA分级变化；术后5天及末次随访时，比较两组腰椎Denis分类及腰背痛情况；通过X线侧位片分析椎体前缘矢状指数及压缩性。
所有患者随访14 - 22个月，平均18.3个月。未发现术后感染、继发性脊髓损伤。对照组1例术后11个月出现内固定断裂，其余内固定无松动。两组手术时间、神经功能恢复情况差异无统计学意义（P > 0.05）。治疗组围手术期失血量及术后引流量少于对照组（P < 0.01）。在腰椎Denis分类及腰背痛方面，治疗组恢复更快，腰背部残留疼痛少于对照组（P < 0.01）。两组术后椎体后凸及椎体前缘压缩均有改善（P < 0.01），两组改善程度差异无统计学意义（P > 0.05）；但末次随访时均存在丢失（P < 0.01），两组椎体后凸丢失差异无统计学意义（P > 0.05）。治疗组椎体前缘矫正丢失存在，但少于对照组。
在严格掌握手术适应证的前提下，经椎旁肌间隙单节段椎弓根螺钉固定治疗胸腰椎骨折，能有效恢复椎体高度、矫正后凸畸形，减少固定节段。与传统经椎旁肌剥离双节段椎弓根螺钉固定手术方法相比，可明显减少手术创伤及出血，减轻腰背部疼痛。近期临床疗效满意。
