Chang Wenli, Zhang Dianling, Liu Wei, Lian Xiaodong, Jiao Zhenqing, Chen Wei
Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University Department of General Surgery, Hebei Youfu Hospital, Shijiazhuang Department of Orthopaedic Surgery, Cangzhou People's Hospital, Cangzhou, PR China.
Medicine (Baltimore). 2018 Jun;97(25):e11193. doi: 10.1097/MD.0000000000011193.
This randomized controlled trial (RCT) aimed to compare the clinical outcomes of thoracolumbar burst fractures (TLBFs) treated with open reduction and internal fixation via the posterior paraspinal muscle approach (PPMA) and the post-middle approach (PA).
Patients with a traumatic single-level TLBFs (T10-L2), treated at our hospital between December 2009 and December 2014, were randomly allocated to Group A (PPMA) and Group B (PA). Sex, age, time from injury to surgery, the American Spinal Injury Association Impairment Scale score (ASIAIS), comorbidities, vertebral level, pre- and postoperative kyphotic angle (KA), visual analog scale (VAS) pain score, and the Oswestry Disability Index (ODI) scores were included in the analysis. Operative time, intraoperative blood loss, x-ray exposure time, postoperative drainage volume, superficial infection, and occurrence of deep infection were documented. The patients were followed up at 2 weeks; 1, 3, and 6 months; 1 and 2 years; and every 6 months thereafter. Radiological assessments were performed to assess fracture union and detect potential loosening and breakage of the pedicle screws and rods at each follow-up. Postoperative VAS and ODI scores were used to evaluate the clinical outcomes.
A total of 62 patients were enrolled (30 in Group A and 32 in Group B, respectively). The operative time (P < .001) and x-ray exposure time (P < .001) in Group A were significantly longer than those in Group B. However, compared to Group B, there were less intraoperative blood loss (P < .001), lower postoperative drainage volume (P < .001), lower VAS scores (2-week (P = .029), 1-month (P = .023), 3-month (P = .047), and 6-month follow-up (P = .010)), and lower ODI scores (2-week, P = .010; 1-month, P < .001; 3-month, P = .028; and 6-month follow-up, P = .033) in Group A.
Although PPMA required a longer operative time and x-ray exposure time, PPMA provided several advantages over PA, including less intra-operative blood loss and lower postoperative drainage volume, and greater satisfaction with postoperative pain relief and functional improvement, than PA, especially at the 6-month follow-up after surgery. Further high-quality multicenter studies are warranted to validate our findings.
本随机对照试验（RCT）旨在比较经椎旁肌后路（PPMA）和后正中入路（PA）切开复位内固定治疗胸腰椎爆裂骨折（TLBFs）的临床疗效。
2009年12月至2014年12月在我院接受治疗的创伤性单节段TLBFs（T10-L2）患者被随机分为A组（PPMA）和B组（PA）。分析包括性别、年龄、受伤至手术时间、美国脊髓损伤协会损伤量表评分（ASIAIS）、合并症、椎体节段、术前和术后后凸角（KA）、视觉模拟量表（VAS）疼痛评分以及Oswestry功能障碍指数（ODI）评分。记录手术时间、术中出血量、X线暴露时间、术后引流量、浅表感染和深部感染的发生情况。患者在术后2周、1、3和6个月、1和2年以及此后每6个月进行随访。每次随访时进行影像学评估，以评估骨折愈合情况，并检测椎弓根螺钉和棒的潜在松动和断裂。术后VAS和ODI评分用于评估临床疗效。
共纳入62例患者（A组30例，B组32例）。A组的手术时间（P<0.001）和X线暴露时间（P<0.001）显著长于B组。然而，与B组相比，A组术中出血量更少（P<0.001）、术后引流量更低（P<0.001）、VAS评分更低（术后2周（P=0.029）、1个月（P=0.023）、3个月（P=0.047）和6个月随访（P=0.010））以及ODI评分更低（术后2周，P=0.010；1个月，P<0.001；3个月，P=0.028；6个月随访，P=0.033）。
虽然PPMA需要更长的手术时间和X线暴露时间，但与PA相比，PPMA具有一些优势，包括术中出血量更少、术后引流量更低，并且术后疼痛缓解和功能改善方面的满意度更高，尤其是在术后6个月随访时。需要进一步的高质量多中心研究来验证我们的发现。
