后路椎管减压结合椎旁肌间隙入路复位植骨内固定治疗胸腰段骨折伴神经损伤Posterior approach decompression combined with paraspinal approach reduction,internal fixation,fusion by bone graft in the treatment of thoracolumbar fracture with neurological deficit
汤勇智;陈勇;王湘江;王贵清;
摘要(Abstract):
[目的]探讨采用后路椎管减压结合椎旁肌间隙入路复位植骨内固定治疗胸腰段骨折伴神经损伤的优越性。[方法]本院2011年10月~2014年2月间,收治胸腰段骨折伴神经损伤患者42例,均采用后路椎板减压复位植骨内固定治疗,其中传统组24例采用传统术式(后正中入路)完成整个手术,改良组18例采用后正中入路减压结合椎旁肌间隙入路复位植骨内固定治疗。对两组手术切口长度、手术时间、术中失血量、手术效果加以对比分析。[结果]相对于传统组,改良组手术切口较小,手术时间较短,术中失血量较少,差异有统计学意义(P<0.05),手术效果则无显著差异(P>0.05)。[结论]采用后路椎管减压结合椎旁肌间隙入路复位植骨内固定治疗胸腰段骨折伴神经损伤是一种合理、微创的手术方式。
关键词(KeyWords): 入路;椎旁肌间隙;胸腰段骨折;神经损伤;治疗
基金项目(Foundation):
作者(Author): 汤勇智;陈勇;王湘江;王贵清;
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DOI:
参考文献(References):
- [1]Arino VL.Our experience in 33 cases of thoracolumbar fracture treated by transpedicle instrument[J].Chir Organi Mov,2000,85(2):161-165.
- [2]Haiyun Y,Rui G,Shucai D,et al.Three-column reconstruction through single posterior approach for the treatment of unstable thoracolumbar fracture[J].Spine(Phila Pa 1976),2010,35(8):295-302.
- [3]徐华梓,倪文飞,黄其杉,等.后路小切口270°减压重建术治疗严重胸腰椎三柱损伤[J].中国脊柱脊髓杂志,2008,18(5):368-372.
- [4]陈晓陇,尚平,温月凤,等.椎旁肌间隙入路与传统后正中入路在胸腰椎后路手术中的应用比较[J].中国脊柱脊髓杂志,2012,22(10):925-930.
- [5]彭茂秀,汤呈宣,林利兴,等.经椎旁肌间隙入路与传统开放式入路手术治疗胸腰段椎体骨折的临床比较[J].中国骨与关节损伤杂志,2013,S1(1):1-2.
- [6]Jiang R,Wu H,Wang JC,et al.Paraspinal approach for thoracolumbar fracture[J].Chin J Traumatol,2011,14(1):3-6.
- [7]Styf JR,Willen J.The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans[J].Spine(Phila Pa1976),1998,23(3):354-358.
- [8]林达生,郭林新,丁真奇,等.椎旁肌间隙入路经伤椎椎弓根植骨内固定治疗胸腰椎骨折[J].中华外科杂志,2011,49(2):125-129.
- [9]Pang W,Zhang GL,Tian W,et al.Surgical treatment of thoracolumbar fracture through an approach via the paravertebral muscle[J].Orthop Surg,2009,1(3):184-188.
- [10]史金辉,杨惠林,王根林,等.椎弓根内固定治疗合并脊髓损伤的胸腰椎骨折[J].中国矫形外科杂志,2007,15(20):1531-1533,1552.