传统后正中入路与Wiltse入路治疗胸腰段骨折的比较

目的：比较传统后正中入路与经椎旁肌入路治疗胸腰段骨折的疗效及预后。方法采用经椎弓根钉棒系统复位固定治疗胸腰段骨折46例，其中经传统后正中入路28例，经Wiltse入路18例。统计分析2组病例围手术期指标、影像学指标及术后疼痛视觉模拟量表（ visual analogue scale ， VAS）评分的差异。结果患者获得随访6～18个月，平均13．6月。 Wiltse入路组较传统入路组的手术时间、住院时间、术中出血量、术后引流量均明显减少（P＜0．05），2组术后患椎前缘高度、后凸Cobb角较术前均有明显恢复（P＜0．05）。2组术后影像学指标差异无统计学意义（P＞0．05）。术前2组VAS评分差异无统计学意义（P＜0．05）。而在术后1周、1个月、6个月及终末随访时， Wiltse入路组与传统入路组间差异有统计学意义（P＜0．05），Wiltse入路组有明显优势。结论 Wiltse入路较后正中入路，具有椎旁肌损伤轻、手术创伤小、术后腰疼症状轻、置钉简便、操作简单等优势，是一种临床易推广和容易掌握的手术方式。

Comparision of Wiltse approach and convertional approach for thoracolumbar junction fractures

Objective To compare the clinical outcomes of Wilste approach and conventional approach for treatment of thoracolumbar fractures. Methods A totoal of 46 patients with throacolumbar fractures undewentr posterior open reduction and internal fixation. Twenty-eight patients were treated with Wiltse approach, the other 18 were treated with conventional approach. Perioperative paraometer, postoperative X-ray, visual analog scale (VAS) score were compared between the 2 groups. Results All the cases were followed up for 6-18 months (average 13.6 months). Wiltse approach had obvious advantages in operation time, hospital stay, blooding loss, volume of drainage. Anterior vertebra height, Cobb's angle between preopration and post-operation were significant difference. The VAS score in Wiltse approach group was significant less than that in conventional approach group at 1 week, 1 month, 6 months, and final follow up. While there weren't significant difference between 2 groups before the surgery. Conclusion The Wiltse approach has the advantage of less tissue injury, less traumas, less pain, easy for pedicle screw insertion, so it's a better option.