经Wiltse椎旁肌间隙入路手术治疗胸腰椎爆裂骨折

目的:探讨Wiltse经椎旁肌入路手术治疗胸腰爆裂骨折的临床疗效及优势。方法:自2008年6月至2010年6月,对手术治疗的53例无明显神经损伤的胸腰椎爆裂骨折患者进行回顾性分析,男43例,女10例,平均41岁(19～62岁)。节段分布:T116例,T1211例,L122例,L214例。其中28例采用经椎旁肌间隙入路,25例采用传统后正中入路。比较两种手术入路的手术时间、术中出血量及术后引流量,并对患者手术前后腰背部VAS评分、伤椎Cobb角和椎体前部塌陷程度的变化以及伤椎椎管正中矢状径变化进行分析。结果:经椎旁肌间隙入路手术与传统后正中手术相比,无论在手术时间、术中出血量、术后引流量还是在腰背痛的视觉模拟评分改善等方面都具有明显优势,两种入路在伤椎Cobb角改善、椎体前缘高度恢复和椎管正中矢径变化方面无明显差异。结论:经椎旁肌间隙入路内固定治疗胸腰椎爆裂骨折可以达到传统后正中入路手术相同的整复效果,而且具有手术创伤小、出血少、操作简便、术后功能恢复快的优点,值得推广。

Surgical treatment of thoracolumbar burst fractures through Wiltse paraspinal approach

Objective:To investigate clinical effects and advantages of Wiltse paraspinal approach to thoracolumbar burst fractures. Methods:From June 2008 to June 2010,the data of 53 patients with thoracolumbar burst fractures with no obviously nerve injury were retrospectively analyzed,including 43 males and 10 females with an average age of 41 years (ranged,19 to 62 years). For segmental distribution,6 cases were T₁₁,11 cases were T₁₂,22 cases were L₁ and 14 cases were L₂. Among them,28 cases were treated with Wiltse paraspinal approach,and 25 cases with postmiddle approach. The operation time,blood loss,postoperative drainage,VAS score of back,Cobb angle of injured cord,changes of collapse of vertebral and median sagittal diameter of injured vertebral were observed. Results:Compared with two methods,there were advantages in improving operation time,blood loss,postoperative drainage and VAS score of back,but there were no significant differences in improving Cobb angle of injuried cord,changes of collapse of vertebral and median sagittal diameter of injuried vertebral. Conclusion:Wiltse paraspinal approach to thoracolumbar burst fractures can achieve the same reduction with postmiddle approach,and has advantages of minimally invasive,less blood,simple operation and rapid recovery,and worth popularizing.