腰椎骨折肌间隙入路_经椎旁肌间隙入路治疗胸腰椎骨折的疗效分析

　　[摘要] 目的 分析经椎旁肌间隙入路治疗胸腰椎骨折的临床疗效，探讨胸腰椎骨折内固定手术的最佳显露方式。 方法 搜集胸腰椎骨折患者90例，并随机分为A、B两组，每组各45例，采用经椎旁肌间隙入路方式的为A组，采用传统后入路方式的为B组，比较两组的临床效果。 结果 手术时间、术中出血量、术后引流量、术后疼痛感觉程度（VAS评分）、切口并发症方面比较，A组明显优于B组，两组比较差异有统计学意义（P 0.05）。 结论 经椎旁肌间隙入路显露方式虽具有操作容易、软组织受损轻微、术中出血量少等优点，但该方式在术中的暴露范围有限，具有手术适应证的局限性，而且其他效果与传统后入路方式无差异，所以建议对于需要行椎板开窗探查、减压、椎管内骨块复位以及需要加用横连接、棘突钢丝内固定的患者，最好选用传统后入路显露方式。
　　[关键词] 胸腰椎骨折；椎弓根内固定；后路；显露方式
　　[中图分类号] R683.2 [文献标识码] A [文章编号] 1673-7210（2012）07（a）-0065-03
　　Analysis of the effect of from thoracolumbar vertebra-side muscle clearance treatment for thoracolumbar fractures
　　ZHOU Shuquan JIANG Jinsong
　　Department of Orthopedics, the Workers′ Hospital of Wuzhou City, Guangxi Autonomous Region, Wuzhou 543000, China
　　[Abstract] Objective To analyze the curative effect of the from thoracolumbar vertebra-side muscle clearance treatment for thoracolumbar fractures, and discuss the best thoracolumbar posterior approaches to treat the thoracolumbar fractures. Methods 90 patients with thoracolumbar fractures were chosen, and were randomly divided into group A and group B, each group for 45 cases, the group A was treated by internal fixation from thoracolumbar vertebra-side muscle clearance, and the group B was treated by the conventional approach, the curative effects of the two groups were compared. Results The operation time, amount of bleeding in the operation, volume of drainage in the operation, post operation pain degree (visual analogue score, VAS), the incidence of incision complications in the group A were better than the group B, there were statistically significant differeces between two groups (P 0.05). Conclusion The thoracolumbar vertebra-side muscle clearance approach has the advantages of handy operation, less soft tissue injury and blood lose, but it has limitations of surgical indication because of the limited expose scope, and the other effects of the two groups are no difference, so if the patient needs to do the laminectomy for examination, decompression, reducetion the intraspinal fracture and internal fixation forunstable fracture by transverse connecting barwith spinous processwire, the conventional approach should be chosen.
　　[Key words] Thoracolumbar fractures; Pedicle internal fixation; Back way; Unfolding fashion