微创医学

目的探讨肌间隙入路伤椎置钉短节段固定微创治疗胸腰椎骨折的临床疗效。方法应用肌间隙入路伤椎置钉短节段固定微创治疗胸腰椎骨折31例。观察术中出血量、手术时间等，术前、术后第3天及末次随访时记录疼痛的VAS评分，测量伤椎压缩率、伤椎后凸Cobb′s角。结果 31例术后获得12～36个月随访，手术时间为（71±18）min，术中出血量为（95±27）mL，术前、术后第3天及末次随访时VAS评分分别为（7.6±1.2）分、（2.0±1.1）分、（0.7±0.6）分；伤椎压缩率分别为（46.2±9.6）%、（8.6±4.4）%、（9.5±3.0）%；伤椎后凸Cobb角分别为（25.2±5.6）°、（7.8±3.1）°、（8.2±2.8）°。术后第3天、末次随访时VAS评分、伤椎压缩率及伤椎后凸Cobb角分别与术前比较差异均有统计学意义，末次随访时伤椎压缩率及伤椎后凸Cobb角与术后第3天比较，差异无统计学意义。结论肌间隙入路伤椎置钉短节段固定微创治疗胸腰椎骨折出血量少、术后疼痛轻、可获得良好的复位与固定，并能维持矫正效果。

Objective To explore the clinical efficacy of minimally invasive treament of injured vertebra pedicle screw fixation through the intermuscular space for thoracolumbar fracture. Method 31 cases with thoracolumbar fracture underwent injured vertebra pedicle screw fixation through the intermuscular space. The blood loss and operative time were observed, the VAS score (Visual analogue scale), injured vertebra compression ratio and injured vertebra kyphosis Cobb angle were recorded at the preoperative period, postoperative third day and the end of followup. Results 31 cases were followed up from 12 months to 36 months. The operative time was (71±18)min, the blood loss was (95±27)mL. At the preoperative period, postoperative third day and the end of followup, the score of VAS were 7.6±1.2, 2.0±1.1, 0.7±0.6, injured vertebra compression ratio were 46.2%±9.6%, 8.6%±4.4%, 9.5%±3.0%, injured vertebra kyphosis Cobb angle were 25.2°±5.6°, 7.8°±3.1°, 8.2°±2.8°. Compared with preoperative period, there were significant improvements in the score of VAS, injured vertebra compression ratio and injured vertebra kyphosis Cobb angle at third postoperative day and the end of followup. There were no significant difference between third postoperative day and the end of followup. Conclusion The minimally invasive treament of injured vertebra pedicle screw fixation through the intermuscular space for thoracolumbar fracture has the advantages of less blood loss, less postoperative pain, better restoration and fixation, and longterm correction maintenance.