Comparison of a Paraspinal Approach with a Percutaneous Approach in the Treatment of Thoracolumbar Burst Fractures with Posterior Ligamentous Complex Injury: a Prospective Randomized Controlled Trial
Comparison of a Paraspinal Approach with a Percutaneous Approach in the Treatment of Thoracolumbar Burst Fractures with Posterior Ligamentous Complex Injury: a Prospective Randomized Controlled Trial
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DOI：
10.1177/147323001204000413
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发表时间：
2012-07-01
影响因子：
1.6
通讯作者：
He, D.
中科院分区：
文献类型：
--
作者：
Jiang, X. Z.;Tian, W.;He, D.
目的：这项前瞻性随机对照研究比较了两种保留椎旁肌肉的手术入路治疗神经功能完整的胸腰椎爆裂性骨折和后韧带复合体损伤的有效性和安全性。方法：将31例患者随机分为经皮椎弓根螺钉-棒内固定组(31例)和椎旁椎弓根螺钉-棒内固定组(30例)，术后随访3年。所有患者均在术前尝试体位复位。结果：与脊柱旁入路相比，经皮入路的术中出血量明显减少，手术时间和住院时间缩短，术后3个月疼痛减轻，功能恢复好。与经皮手术相比，脊柱旁手术矫正脊柱后凸和恢复椎体高度明显更好。两组患者的长期临床结果没有差异。结论：在体位复位成功的病例中，微创经皮途径似乎是更好的方法。脊柱旁入路可获得更好的手术矫正效果，因此推荐用于体位复位不成功的患者。
OBJECTIVE: This prospective randomized controlled study compared the efficacy and safety of two paraspinal muscle-sparing surgical approaches for the management of neurologically intact patients with thoracolumbar burst fractures and posterior ligamentous complex injuries. METHODS: Patients were randomized to undergo either percutaneous (n = 31) or paraspinal (n = 30) fluoroscopically-guided pedicle screw-rod fixation, and were followed for >= 3 years. Preoperative postural reduction was attempted in all patients. RESULTS: The percutaneous approach was associated with significantly less intraoperative blood loss and shorter duration of surgery and hospitalization, as well as less pain and better functional recovery at 3 months after surgery compared with the paraspinal approach. Paraspinal surgery resulted in significantly better correction of kyphosis and restoration of vertebral height compared with percutaneous surgery. There were no differences in long-term clinical outcomes between the two groups. CONCLUSIONS: The minimally invasive percutaneous approach appears to be better in cases of successful postural reduction. The paraspinal approach results in better surgical correction and is, therefore, recommended for patients without successful postural reduction.