经Wiltse入路联合伤椎固定治疗无神经损伤胸腰段 骨折的临床疗效分析

目的探讨经Wiltse入路联合伤椎固定治疗无神经损伤胸腰段骨折的临床疗效。方法对2011年1月至2017年3月收治的73例胸腰段单一椎体骨折患者的临床资料进行回顾性分析。按手术方式的不同分为两组:A组为传统后正中入路跨伤椎固定组,共33例;B组为经Wiltse入路联合伤椎固定组,共40例。比较两组患者一般情况:手术时间、手术前后血红蛋白差值、下地时间;临床症状:视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI);影像学指标:术后1周伤椎前缘高度比、Cobb角及末次随访伤椎前缘高度比、Cobb角。结果所有患者获得随访,时间为11～20个月,平均15.6个月,术后均无内固定松动、断裂等并发症的发生。B组在手术时间、血红蛋白差值、下地时间以及VAS评分、腰椎ODI评分方面均优于A组,差异有统计学意义(P 0.05);术后1周伤椎前缘高度比、Cobb角2组间差异无统计学意义(P 0.05);末次随访时B组相比于A组,伤椎前缘高度比、Cobb角丢失较少,差异有统计学意义(P0.05)。结论经Wiltse入路联合伤椎固定,具有手术时间短、出血少、痛苦小、术后康复快及并发症少等优点,且伤椎高度及Cobb角恢复满意,值得临床推广。

CLINICAL EFFICACY OF WILTSE APPROACH COMBINED WITH INTERMEDIATE PEDICLE SCREW IN THE TREATMENT OF THORACOLUMBAR FRACTURES WITHOUT NERVE INJURY SYMPTOMS

Objective:To discuss the clinical efficacy of thoracolumbar fractures treated by wiltse approach combined with intermediate pedicle screw. Methods:A total of 73 cases of single thoracolumbar fractures were selected in the hospital between January 2011 and March 2017. According to the different fixation methods, they were divided into two groups, A group:traditional posterior midline approach across the injured vertebral fixation in 33cases; B group:paraspinal muscle space approach combined with intermediate pedicle screw in 40 cases. The indexes as operation time, HGB, down time, VAS and ODI scores, the correction of the fractured vertebrae height and kyphosis angle postoperatively and the fractured vertebrae height and kyphosis angle at the final follow-up and so on were compared between the two groups. Results: All the patients were followed up from 11 to 20 months with an average of 15.6 months. No complications such as loosening of internal fixation and fracture occurred after operation. There was no significant difference in the correction of the fractured vertebrae height and kyphosis angle on one week after surgery among the two groups (P > 0.05). The operation time, HGB, down time, VAS score and ODI score in B group were significantly better than those in A group; it was inverse for the losing rate of the fractured vertebrae height and kyphosis angle at the final follow-up (P < 0.05). Conclusion: The wiltse approach combined with intermediate pedicle screw is an good way for treating thoracolumbar fractures. This method has advantages of short operative time, less blood loss, rapid recovery. Meanwhile, it can maintain good reduction and stable fixation, which was worthy of clinical promotion.