后路入路和椎旁入路治疗胸腰椎爆裂骨折的比较:一项随机对照试验

Satapong Pisuitthanakan, MD
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引用次数: 0

摘要

目的:爆裂性骨折导致超过一半的胸腰椎骨折,后路入路被认为是标准入路。经证实,椎旁入路治疗胸腰椎损伤安全有效。本研究旨在比较两种入路的临床和影像学结果。方法:本随机对照试验纳入2016年7月至2018年8月24例孤立性胸腰椎爆裂骨折患者。患者分为椎旁入路和后路入路两组。主要观察指标为术后第1、2、3、14天的疼痛。校正了科布的角度;操作时间;术中出血量;第1、2、3天阿片类药物使用情况;Oswestry残疾指数(ODI,泰文版);3个月时减少损失的百分比是次要结果。在干预后第1、2、3、14和90天对参与者进行评估。结果:术后第1、2、3、14天VAS平均评分(8.6±0.8、7.1±0.6、5.5±1.3、5.5±0.8);术中出血量(395.8±113.7 mL);第2天和第3天阿片类药物使用(13±1.5 mg, 8.3±1.9 mg);脊柱旁入路组术后ODI(23.5±3.5)明显低于后入路组(术后第1、2、3、14天平均VAS[9.2±0.5,8.3±0.3,7.5±0.8,6.7±0.5])(P<0.05);术中出血量[590±70.1 mL];第2、3天阿片类药物用量[15.8±1.9 mg, 11.7±1.6 mg];术后ODI[40±4.2])。两组在手术时间、矫正Cobb角和复位损失百分比方面无统计学差异。结论:棘旁入路在术后疼痛、术中出血量、阿片类药物使用和3个月ODI方面明显优于传统后路,从而证实了微创概念。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of the Posterior and Paraspinal Approaches for the Treatment of Thoracolumbar Burst Fractures: A Randomized Controlled Trial
Purpose: Burst fractures cause over half of all thoracolumbar fractures, for which the posterior approach has been considered the standard approach. The paraspinal approach has proven safe and effective for thoracolumbar injury. This study aimed to compare the clinical and radiographic outcomes between the two approaches. Methods: This randomized controlled trial included 24 patients with isolated thoracolumbar burst fractures between July 2016 and August 2018. Patients were categorized into two groups: paraspinal and posterior approaches. The primary outcome was postoperative pain on days 1, 2, 3, and 14. The corrected Cobb’s angle; operation time; intraoperative blood loss; opioid usage on days 1, 2, and 3; Oswestry Disability Index (ODI, Thai version); and percentage reduction loss at 3 months were secondary outcomes. Participants were assessed on post-intervention days 1, 2, 3, 14, and 90. Results: The mean visual-analog-scale (VAS) scores on postoperative days 1, 2, 3, and 14 (8.6 ± 0.8, 7.1 ± 0.6, 5.5 ± 1.3, 5.5 ± 0.8); intraoperative blood loss (395.8 ± 113.7 mL); opioid usage on days 2 and 3 (13 ± 1.5 mg, 8.3 ± 1.9 mg); and postoperative ODI (23.5 ± 3.5) were significantly lower (P<0.05) in the paraspinal-approach group than in the posterior-approach group (mean VAS on postoperative days 1, 2, 3, and 14 [9.2 ± 0.5, 8.3 ± 0.3, 7.5 ± 0.8, 6.7 ± 0.5]; intraoperative blood loss [590 ± 70.1 mL]; opioid usage on days 2 and 3 [15.8 ± 1.9 mg, 11.7 ± 1.6 mg]; and postoperative ODI [40 ± 4.2]). There was no statistical differences in operative time, corrected Cobb’s angle, and percentage reduction loss. Conclusions: The paraspinal approach is significantly advantageous over the conventional posterior approach regarding postoperative pain, intraoperative blood loss, opioid usage, and ODI at 3 months, thus corroborating the minimally invasive concept.
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