后路經椎旁肌間隙入路椎弓根螺釘內固定對腰椎骨折患者關節與功能恢復及血清磷酸肌酸激酶水平的影響

湯雄飛　錢越寧　顧宣歆　孫彥　阮朝陽

[摘要] 目的 分析后路經椎旁肌間隙入路椎弓根螺釘內固定對腰椎骨折患者關節與功能恢復及血清磷酸肌酸激酶水平的影響。 方法 選取我院從2014年7月～2016年9月收治的110例腰椎骨折患者病患為研究對象，抽簽法隨機分為兩組，對照組進行椎弓根入螺釘內治療，實驗組經后路頸椎旁間隙入路椎弓根螺釘內固定治療，比較兩組的關節恢復功能與血清磷酸肌酸激酶水平等。 結果 對照組患者術中出血量為（322.6±22.8）mL、術后引流量為（108.6±18.4）mL，矯正率為（82.6±4.4）%，椎弓根釘植入為（98.6±4.2）%，手術時間為（154.8±13.5）min，實驗組患者術中出血量為（173.5±19.3）mL，術后引流量為（68.9±12.4）mL，矯正率為（83.2±4.3）%，椎弓根釘植入為（98.8±3.6）%，手術時間為（129.4±16.3）min，實驗組術中出血量、術后引流量、手術時間低于對照組，具有差異性（P<0.05）；實驗組在術前VAS分數為（7.6±1.0）分，術后兩周為（3.2±0.9）分，術后1個月為（1.5±0.4）分，術后6個月為（0.6±0.3）分，對照組在術前VAS分數為（7.5±1.0）分，術后兩周為（4.5±1.2）分，術后1個月為（3.9±0.8）分，術后6個月為（2.8±0.6）分，具有差異性（P<0.05），實驗組手術前，實驗組血清磷酸肌酸激酶活性[（65.92±4.54）U/mL]，手術后為[（54.92±3.89）U/mL]，對照組為血清磷酸肌酸激酶活性[（64.34±2.54）U/mL]，手術后為[（42.56±3.28）U/mL]，實驗組高于對照組，具有差異性（P<0.05）。 結論 腰椎骨折患者實施手法復位聯合后路經椎旁肌間隙入路椎弓根螺釘內固定治療提高療效，縮短患者手術時間和住院時間，減輕患者疼痛，改善血清磷酸肌酸激酶活性，具有臨床應用價值。

[關鍵詞] 后路經椎旁肌間隙；椎弓根螺釘內固定；腰椎骨；血清磷酸肌酸激酶

[中圖分類號] R683.2 [文獻標識碼] B [文章編號] 1673-9701（2017）13-0071-04

[Abstract] Objective To analyze the effect of screw internal fixation in pedicle of vertebral arch via posterior paravertebral muscle gap approach on joint and functional recovery and serum creatine phosphokinase levels in the patients with lumbar fractures. Methods 110 patients with lumbar fractures in our hospital from January 2014 to September 2016 were selected as the study subjects. They were randomly divided into two groups according to the drawing lot method. The control group was given screw internal fixation in pedicle of vertebral arch， and the experimental group was given screw internal fixation in pedicle of vertebral arch via posterior paravertebral muscle gap approach. The joint recovery function and serum creatine phosphokinase levels were compared between the two groups. Results In the control group， the intraoperative blood loss was（322.6±22.8）mL， the postoperative drainage was（108.6±18.4）mL， the correction rate was（82.6±4.4）%， the pedicle screw implantation was（98.6±4.2）%， and the operation time was（154.8± 13.5）min. In the experimental group， the intraoperative blood loss was（173.5±19.3）mL， the postoperative drainage was（68.9±12.4）mL， the correction rate was（83.2±4.3）%， the pedicle screw implantation was （98.8±3.6）%， and the operation time was（129.4±16.3）min. The intraoperative blood loss， postoperative drainage volume and operation time in the experimental group were lower than those in the control group， and the differences were significant（P<0.05）； in the experimental group， the VAS score before the surgery was（7.6±1.0）， the score 2 weeks after the surgery was（3.2±0.9）， the score 1 month after the surgery was（1.5±0.4）， and the score 6 months after the surgery was（0.6±0.3）. In the control group， the VAS score before the surgery was（7.5±1.0）， the score 2 weeks after the surgery was（4.5±1.2）， the score 1 month after the surgery was（3.9±0.8）， and the score 6 months after the surgery was （2.8±0.6）. The differences were significant（P<0.05）. In the experimental group， the serum creatine phosphokinase activity was[（65.92±4.54）U/mL] before the surgery， and[（54.92±3.89）U/mL ]after the surgery. In the control group， the serum creatine phosphokinase activity was [（64.34±2.54）U/mL] before the surgery， and[（42.56±3.28）U/mL] after the surgery. The experimental group was higher than the control group， and the differences were significant（P<0.05）. Conclusion Manual reduction combined with screw internal fixation in pedicle of vertebral arch via posterior paravertebral muscle gap approach in the patients with lumbar fractures can improve the efficacy， shorten the operation time and length of stay， reduce the pain and improve the activity of serum creatine phosphokinase， which is of clinical application value.

[Key words] Posterior paravertebral muscle gap approach； Screw internal fixation in pedicle of vertebral arch； Lumbar vertebra； Serum creatine phosphokinase

臨床上治療腰椎骨采用椎弓根入螺釘內治療，這種治療方法對患者造成很大的創傷[1]，如住院時間長、流血量多、疼痛程度重等，采用后路經椎旁肌間隙入路椎弓根螺釘治療，相對于椎弓根入螺釘內治療[2]，操作簡單，手術時間、住院時間短，流血量少，減少椎旁肌肉的損傷，從而減輕患者的痛苦[3]。我院選取我院從2014年7月～2016年9月收治的110例腰椎骨折患者進行治療，現報道如下。

1 資料與方法

1.1 一般資料

選取從2014年7月～2016年9月來我院骨科進行治療的腰椎骨折的患者110 例，抽簽法隨機分為兩組。對照組55 例患者中，男30 例，女25 例，年齡最大62 歲，最小19 歲，平均（42.7±4.6）歲，骨折部位T11為5 例，T12為23例，L1為14例，L2為8 例，T11～12為3例，T12～L1為2 例。……