扩张管辅助下Wiltse入路小关节融合短节段内固定治疗不稳定胸腰椎骨折

目的探讨扩张管辅助下Wiltse入路小关节融合短节段内固定治疗不稳定胸腰椎骨折的临床疗效。方法回顾性分析自2014-01—2017-06采用扩张管辅助后路经Wiltse入路小关节融合伤椎置钉短节段内固定治疗的42例不稳定胸腰椎爆裂骨折,比较手术前后椎体楔形角、椎体前缘高度、椎体后缘高度、椎体横断面积、腰痛VAS评分。结果42例均顺利完成手术且获得完整随访,随访时间平均18个月。术后2例合并尿道相关泌尿系感染,1例合并伤口皮缘坏死,未出现伤口感染、血管及脊髓损伤、神经根损伤、内固定松动等并发症。术后椎体楔形角角度、椎体前缘高度、椎体后缘高度、椎体横断面积、腰痛VAS评分较术前均显著改善,差异有统计学意义(P<0.05)。结论扩张管辅助下Wiltse入路小关节融合短节段固定治疗不稳定型胸腰椎骨折手术创伤小,术后恢复快,有良好的临床及影像学表现。

Treatment of unstable thoracolumbar fractures with dilation-tube-assisted Wiltse approach and facet joint fusion combined short segment internal fixation

Objective To investigate the clinical effect of dilation tube assisted Wiltse approach and facet joint fusion combined short segment fixation for unstable thoracolumbar fractures.Methods Retrospective analysis was performed on 42 cases of unstable thoracolumbar burst fractures treated from January 2014 to June 2017 with dilation tube-assisted lower posterior Wiltse approach facet joint fusion combined short segment internal fixation,and anterior and posterior vertebral wedge angle,anterior height of vertebral body,posterior edge height of vertebral body,transection area of vertebral body,low back pain VAS score were compared.Results All 42 patients underwent successful operation and completed follow-up,with an average follow-up time of 18 months.There were 2 cases of postoperative urinary tract-related infection and 1 case of necrosis of wound skin margin without complications such as wound infection,vascular and spinal cord injury,nerve root injury and loosening of internal fixation.The vertebral wedge angle,the height of the anterior edge of the vertebral body,the height of the posterior edge of the vertebral body,the cross-sectional area of the vertebral body,the low back pain VAS score were significantly improved after operation(P<0.05).Conclusion Dilation-tube-assisted Wiltse approach and facet joint fusion combined short segment internal fixation for treatment unstable thoracolumbar fractures internal has good clinical and imaging performance with small trauma and fast postoperative recovery.