柳海铭 张沿洲 张圣兵 胡 牮 刘 政 王根林.江苏省昆山市第四人民医：骨科，江苏昆山2533曰2.苏州大学附属第一医：骨科，江苏苏州25006

    椎旁肌间隙入路椎弓根螺钉内固定治疗胸腰段脊柱骨折的临床效果

    柳海铭1张沿洲1张圣兵1胡牮1刘政1王根林2▲

    1.江苏省昆山市第四人民医：骨科，江苏昆山215331曰2.苏州大学附属第一医：骨科，江苏苏州215006

    目的探讨椎旁肌间隙入路椎弓根螺钉内固定治疗胸腰段脊柱骨折的临床效果。方法选择2007年7月~ 2015年6月江苏省昆山市第四人民医：和苏州大学附属第一医：收治的49例胸腰段脊柱骨折患者为研究对象，根据手术入路方式的不同将其分为观察组(25例)和对照组(24例)。观察组采用Wiltse肌间隙入路联合伤椎置钉短节段固定治疗，对照组采用传统剥离椎旁肌后入路伤椎置钉短节段固定治疗。比较两组患者的手术时间尧手术出血量尧术后下地时间曰观察两组患者术前及术后1 d尧1周尧2周尧6个月时腰背部疼痛情况曰观察两组患者手术前尧术后下地前和末次随访时X线片上椎体高度曰记录两组患者手术并发症及内固定松动尧断裂情况。结果观察组手术时间尧手术出血量尧术后下地时间均少于对照组，差异均有统计学意义(P0.05)。结论椎旁肌肌间隙入路治疗胸腰段骨折具有手术时间短，术中出血量少尧创伤小尧术后恢复快，疗效确切等优点。

    椎旁肌间隙入路；胸腰椎骨折；内固定

    [Avsteact]Ov jective To explore the clinic effect of paraspinal sacrospinalis-splitting approach for the treatment of thoracolumbar fractures.M ethods A total of 49 patients with thoracolumbar fractures were included from July 2007 to June 2015 in Kunshan Fourth People's Hospital and the First Affiliated Hospital of Soochow University were selected as the study objects,and were assigned to observation group(n=25)and control group(n=24)according to the differ—entmethods of surgical approach.Sacrospinalis-splitting approach plus vertebral nailing fixation was used in patients of the observation group,vertebralmuscle posterior approach plus vertebral nailing fixation was used in patients of the control group.Operation time,the amount of operative bleeding,ambullation time after operation of two groups were compared;pain of waist and back of two groups before operation and 1 d,1 week,2 weeks,6 months after operation were observed;vertebral body height of patients in two groups before operation,down before postoperation and at the time of the last follow-up on the X ray film;surgical complications and the status of internal fixation loosening and fracture of patients in the two groupswere observed.Results Operation time,the amount of operative bleeding,ambul—lation time of the observation group after operation were less than those of the control group,the differenceswere statis—tically significant(P0.05).Conclusion Thoracic and lumbar paraspinal approach for treatment of thora—columbar fracture has the advantages of shorter operation time,less bleeding,less trauma,postoperative recovery faster, obvious curative effect.[Key woeds]Paraspinal sacrospinalis-splitting ap—proach;Thoracolumbar fracture;Internal fixation ......