Pedicle screw paraspinal muscle approach versus posterior median approach fixation for thoracolumbar fractures: comparison of the stability

doi:10.3969/j.issn.2095-4344.2014.40.010

Abstract

Abstract:

BACKGROUND: Spinal posterior surgery is the most common treatment method for thoracolumbar fracture. During exposure of conventional posterior surgery, a wide-range stripping and pulling of paraspinal muscles easily induced failure syndrome of lumbar surgery.

OBJECTIVE: To compare the reset conditions and stability of thoracolumbar fractures after treatment with pedicle screw paraspinal muscle approach and conventional posterior median approach fixation.

METHODS: A total of 62 patients with thoracolumbar fractures without nerve injury were retrospectively analyzed. 22 patients were treated with paraspinal muscle approach and general spine system. 21 patients were treated with conventional median approach and general spine system. 19 patients were treated with conventional median approach and AF internal fixation system. The therapeutic effects of the three kinds of fixation methods were compared by comparing clinical indexes in patients of the three groups, including operation time, intraoperative blood loss, postoperative drainage, dead space volume, scores of the Visual Analogue Scale of back pain, wound complications, height of injured vertebrae and the Cobb angle.

RESULTS AND CONCLUSION: Operation time, intraoperative blood loss, postoperative drainage and dead space volume were better in the paraspinal muscle approach and general spine system group than in the conventional median approach and general spine system group and conventional median approach and AF internal fixation system group (P < 0.05). No significant difference in height of injured vertebrae and the Cobb angle was detectable among the three groups at 3 days after fixation (P > 0.05). No significant difference in scores of the Visual Analogue Scale of back pain was visible among the three groups at 1 week after fixation (P > 0.05). The scores of the Visual Analogue Scale of back pain were apparently lower in the paraspinal muscle approach and general spine system group than in the conventional median approach and general spine system group and conventional median approach and AF internal fixation system group at 3 and 6 months after fixation. No incision infection was observed in patients of the three groups. These results suggested that compared with conventional posterior median approach, paraspinal muscle approach has some advantages, such as small trauma, less bleeding, postoperative rapid recovery, and high degree of satisfaction. The effects of general spine system and AF internal fixation system in the repair of thoracolumbar fractures on internal fixation are similar, but general spine system has some advantages such as simple to be operated, save time, less bleeding, stable fixation and good reduction. General spine system combined with paraspinal muscle approach is a good method to repair thoracolumbar spine fracture.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: thoracic vertebrae, lumbar vertebrae, fractures, bone, internal fixators, follow-up studies

CLC Number:

R318

Zhang Zhao-chuan, Ma Chao, Wu De-hui, Wu Ji-bin, Dai Wei-xiang, Wang Zhao-hong, Han Meng,Feng Jie, Liu Guang-pu. Pedicle screw paraspinal muscle approach versus posterior median approach fixation for thoracolumbar fractures: comparison of the stability[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(40): 6451-6458.

Figures/Tables 3

2.1 参与者数量分析按意向性处理，纳入患者62例，全部进入结果分析，治疗过程中无脱落。随访时间9-18个月。 2.2 基线资料比较 3组患者内固定前一般情况相比，差异无显著性意义(P > 0.05)，见表1。 2.3 手术时间、出血量、术毕切口内残腔体积、术后引流量比较椎旁肌间隙入路并GSS内固定组手术时间、术中出血量明显少于传统正中入路并GSS内固定组、传统正中入路并AF内固定组，而传统正中入路并GSS内固定组手术时间、术中出血量又少于传统正中入路并AF内固定组，差异有显著性意义(P < 0.05)。术毕切口内残腔体积、术后引流量比较，椎旁肌间隙入路并GSS内固定组少于传统正中入路并GSS内固定组、传统正中入路并AF内固定组(P < 0.05)；而传统正中入路并GSS内固定组与传统正中入路并AF内固定组间差异无显著性意义(P > 0.05)，见表2。 2.4 伤椎高度及Cobb角比较内固定后3组患者伤椎高度均显著高于内固定前，3组患者内固定后复查的伤椎高度及Cobb角比较，差异无显著性意义(P > 0.05)，见表3。 2.5 腰背痛目测类比评分比较内固定前及内固定后1周，3组比较差异无显著性意义。而内固定后3，6个月，椎旁肌间隙入路并GSS内固定组目测类比评分优于传统正中入路并GSS内固定组、传统正中入路并AF内固定组，见表4。 2.6 不良事件 3组患者均未见切口感染。传统正中入路并AF内固定组有1例发生螺钉断裂，1例复位后椎体稍回缩；而椎旁肌间隙入路并GSS内固定组、传统正中入路并GSS内固定组则无断钉、断棒和复位后椎体回缩现象发生。 2.7 典型病例分析病例1：女性患者，29岁，因车祸外伤致胸背部疼痛、活动受限3 h就诊，急诊行X射线检查提示L1椎体压缩骨折。入院行腰椎CT、MR检查进一步明确诊断，疼痛目测类比评分8分。患者采用椎旁肌间隙入路并GSS内固定系统治疗，治疗后3 d复查腰椎正侧位X射线片。治疗后15个月随访疼痛目测类比评分2分，骨折愈合良好，内固定未见松动及断钉短棒，见图1。病例2：男性患者，37岁，因重物砸伤致胸背部疼痛、活动受限1 d就诊，入院行行X射线、腰椎CT、MR检查提示T12椎体压缩骨折。疼痛目测类比评分9分。患者采用传统正中入路并GSS内固定系统治疗，治疗后3 d复查腰椎正侧位X射线片。治疗后12个月随访疼痛目测类比评分3分，骨折愈合良好，见图2。病例3：女性患者，32岁，因高处坠落伤致腰背部疼痛、活动受限10 h就诊，急诊行X射线、腰椎CT检查提示L2椎体压缩骨折。入院行MR检查进一步明确诊断，疼痛目测类比评分9分。患者采用传统正中入路并AF内固定系统治疗治疗，治疗后3 d复查腰椎正侧位X射线片，椎体高度复位满意。治疗后12个月随访疼痛目测类比评分3分，一侧螺钉断裂，椎体骨性愈合，未见高度丢失，见图3。"

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