摘要
目的比较经肌间隙入路复位固定与经后路复位固定椎间融合治疗胸腰椎骨折的疗效。方法选取2015年4月至2017年12月武装警察部队广东省总队医院脊柱外科收治的154例车祸致胸腰椎骨折患者作为研究对象,按手术方式不同分为对照组(n=78)和观察组(n=76),对照组采用后路复位固定椎间融合,观察组采用肌间隙入路复位固定。比较两组患者手术时间、术中出血量、住院时间及住院费用、功能恢复情况、Frankel分级及并发症发生率。结果观察组手术时间、术中出血量、住院时间及住院费用均明显少于对照组[(157±43) min比(210±60) min,(741±172) m L比(1 188±179) m L,(11. 3±4. 3) d比(19. 2±5. 1) d,(2. 5±0. 8)万元比(4. 01±0. 8)万元](P <0. 01)。两组Cobb角及伤椎高度恢复值、丢失值比较差异无统计学意义(P> 0. 05)。术后6个月两组视觉模拟评分、Roland-Morris功能障碍评分均显著下降(P <0. 05),但组间比较差异无统计学意义(P>0. 05),时点间、组间·时点间交互作用差异有统计学意义(P <0. 001)。两组Frankel分级及并发症发生率比较差异均无统计学意义(P> 0. 05)。结论经肌间隙入路复位固定与经后路复位固定椎间融合治疗胸腰椎骨折的疗效均较满意,且安全性较好,但经肌间隙入路复位固定的手术时间更短、术中出血量更少,术后恢复更快。
Objective To analyze the curative effect of reduction fixation by intermuscular space approach and reduction fixation interbody fusion by posterior approach on thoracolumbar fracture. Methods From Apr. 2015 to Dec. 2017,154 patients with thoracolumbar fractures caused by car accidents were divided into a control group( posterior reduction fixation interbody fusion,n = 78) and an observation group( intermuscular space approach reduction fixation,n = 76). The operation time,intraoperative hemorrhage,hospitalization time,hospitalization cost,functional recovery,Frankel classification and complication rate were compared between the two groups. Results The operation time,intraoperative blood loss,hospitalization time and hospitalization cost of the observation group were significantly lower than those of the control group [( 157 ± 43) min vs( 210 ±60) min,( 741 ± 172) m L vs( 1 188 ± 179) m L,( 11. 3 ± 4. 3) d vs( 19. 2 ± 5. 1) d,( 25 ± 8) thousand yuan vs( 40. 1 ±8) thousand yuan]( P < 0. 01). There was no significant difference in Cobb angle and the recovery and loss of injured vertebra height between the two groups( P > 0. 05). Six months after operation,Visual analogue scale and RolandMorris disability questionnaire scores of the two groups decreased significantly( P < 0. 05),but there was no significant difference between the two groups( P > 0. 05),and there was significant difference between different time points,and interactions of groups · time points( P < 0. 001). There was no significant difference between the two groups in Frankel classification and the incidence of complications( P > 0. 05). Conclusion The results of the treatment of thoracolumbar fractures by intermuscular approach and posterior approach are satisfactory and safe,but the intramuscular approach is featured with shorter operation time,less bleeding and faster recovery.
作者
曾辉
姚楚亮
杨焱鑫
陈杰
王华仁
廖臻
ZENG Hui;YAO Chuliang;YANG Yanxin;CHEN Jie;WANG Huaren;LIAO Zhen(Departments of Spice Surgery,Guangdong General Hospital of the People′s Armed Police Force of China,Guangzhou 510507,China)
出处
《医学综述》
2020年第4期819-822,828,共5页
Medical Recapitulate
关键词
胸腰椎骨折
经肌间隙入路复位固定
经后路复位固定椎间融合
Thoracolumbar fracture
Reduction fixation by intermuscular space approach
Reduction fixation interbody fusion by posterior approach
