| 单侧Wiltse肌间隙入路对侧椎板减压治疗胸腰段爆裂性骨折 |
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Received:October 18, 2016
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| 作者 | Author | 单位 | Unit | E-Mail |
| 李驰 |
LI Chi |
温州医科大学附属第一医院骨科, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hostpital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
lch94696@163.com |
| 王靖 |
WANG Jing |
温州医科大学附属第一医院骨科, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hostpital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
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| 滕红林 |
TENG Hong-lin |
温州医科大学附属第一医院骨科, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hostpital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
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| 朱旻宇 |
ZHU Ming-yu |
温州医科大学附属第一医院骨科, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hostpital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
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| 周洋 |
ZHOU Yang |
温州医科大学附属第一医院骨科, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hostpital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2017年30卷，第5期，第453-457页 |
| DOI：10.3969/j.issn.1003-0034.2017.05.012 |
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目的：比较经后正中单侧肌间隙入路对侧肌肉剥离椎板减压与两侧肌肉剥离单侧减压治疗脊柱胸腰段爆裂性骨折的效果及其对多裂肌损伤的影响。
方法：自2010年1月至2014年12月，采用后路椎弓根螺钉固定，单侧椎板减压治疗胸腰段爆裂性骨折43例，男29例，女14例；年龄21～64岁，平均42.3岁。根据非减压侧手术入路不同分为肌间隙入路组（A组）和多裂肌剥离入路组（B组）.记录两组的手术时间、术中出血量。评估两组患者术前1 d、术后1周、术后12个月腰背痛视觉模拟评分（visual analogue scale，VAS）.所有患者术前、术后12个月进行CT检查，并对两组患者两侧多裂肌、椎管进行CT测量。
结果：43例患者术后均获随访，时间14～21个月，平均16.3个月。3例患者术后创口部分未愈合，予清创缝合换药后治愈；无断钉发生。A组与B组比较，患者手术时间、术中出血量差异有统计学意义（P<0.05）.两组患者腰背部VAS评分术前1 d、术后1周、术后12个月比较差异无统计学意义（P>0.05）.CT测量：所有患者伤椎椎管狭窄率手术后明显缩小（P<0.05），A组两侧多裂肌手术前后面积及密度变化差异有统计学意义（P<0.05），B组两侧多裂肌手术前后面积及密度变化差异无统计学意义（P>0.05）.所有患者术后神经功能恢复正常。
结论：单侧椎旁肌间隙入路对侧椎板减压治疗脊柱胸腰段爆裂性骨折，疗效确切；与两侧多裂肌剥离入路比较，创伤小，对多裂肌损伤小。 |
| [关键词]:胸腰段骨折 手术入路 减压 |
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| Unilateral Wiltse intermuscular approach and contralateral decompression for the treatment of thoracolumbar burst fracture |
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Abstract:
Objective: To compare the clinical effects and multifidus muscle injury of different approaches,including unilateral Wiltse intermuscular approach and intramuscular approach combined with contralateral decompression,in treating thoracolumbar burst fracture.
Methods: Forty-three patients with thoracolumbar burst fracture were enrolled in the study from January 2010 to December 2014,including 29 males and 14 females with an average age of 42.3 years old(ranged from 21 to 64 years old). The patients were treated with posterior pedicle screw fixation and unilateral decompression and were divided into Wiltse intermuscular approach group (group A) and intramuscular approach group (group B) according to surgical approach. Operation time and intraoperative bleeding were recorded for all patients;visual analogue scale(VAS) was compared 1 d preoperatively,1 week,12 months postoperatively between two groups;preoperation and 12 months postoperatively,the fractured vertebral canal and two-sides multifidus muscle of the same section were observed and compared by CT measure between two groups.
Results: All the patients were follow-up for 14 to 21 months with an average of 16.3 months. Partial wound non-healing occurred in 3 patients and the wound ultimately healing after debridgement suture and change dressings. No screw breakage was found. There was significant difference in operation and intraoperative bleeding operation between two groups (P<0.05),while there was no significant difference in VAS score of 1 d preoperatively,1 week,12 months postoperatively between two groups(P>0.05). As for CT measurement results,postoperative vertebral canal narrow ratio was significant decreased in all patients(P<0.05),while perioperative changes of the two-sides multifidus muscle cross section area and density were significant in group A (P<0.05),but there was no significant difference in group B (P>0.05). Neurologic status of all patients got recovery at final follow-up.
Conclusion: The method of unilateral Wiltse intermuscular approach combined with contralateral decompression for the treatment of thoracolumbar burst fracture has good clinical effects,also it is less invasive and less damage to multifidus muscle compared with intramuscular approach. |
| KEYWORDS:Thoracolumbar fracture Surgical approach Decompression |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李驰,王靖,滕红林,朱旻宇,周洋.单侧Wiltse肌间隙入路对侧椎板减压治疗胸腰段爆裂性骨折[J].中国骨伤,2017,30(5):453~457 |
| 英文格式: | LI Chi,WANG Jing,TENG Hong-lin,ZHU Ming-yu,ZHOU Yang.Unilateral Wiltse intermuscular approach and contralateral decompression for the treatment of thoracolumbar burst fracture[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(5):453~457 |
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