Wiltse入路与传统后正中入路手术治疗胸腰段椎体骨折的临床比较研究

目的探讨胸腰段椎体骨折经Wiltse入路与传统后正中手术入路置入椎弓根螺钉棒系统的临床治疗效果,并进行比较。方法选骨外科收治并实施手术的单节段胸腰椎骨折患者47例,入院后随机分为两组进行手术治疗。Wiltse入路组25例,传统后正中入路组22例,均在入院1周内应用椎弓根钉棒系统行椎体骨折复位内固定手术。记录并分析、比较两组不同入路的手术效果、伤椎Cobb角纠正率、VAS评分法评估切口区域腰背痛的疼痛程度、血清中骨骼肌损伤的标志物肌酸激酶(CK)含量、术后复查MRI显示的多裂肌副损伤程度的情况指标。结果两组在伤椎Cobb角纠正率比较中无显著差异(P0.05);Wiltse入路组手术时间、术中患者创面渗血量、术后引流管引流计量、腰背痛VAS评分均低于传统后正中入路组,差异有统计学意义(P0.05);Wiltse入路组CK值及术后1年MRI评分亦明显低于传统后正中入路组,差异有临床统计学意义(P0.05)。结论胸腰段椎体骨折经Wiltse入路置入椎弓根螺钉棒系统可减少椎旁肌的副损伤,有效避免多裂肌的瘢痕变性,缩短手术时间,减少手术出血量,明显减轻术后慢性腰背痛,且操作简单,值得在临床上推广应用。

A comparative study on clinical effect between Wiltse approach and conventional postmiddle approach in surgical treatment of thoraco-lumbar fracture

Objective To explore the effect of treatment of thoracic lumbar vertebral fracture with Wiltse approach and traditional middle surgical approach of pedicle screw rod system,and compare their results. Methods In this prospective study,47 patients with single thoracolumbar fracture were divided into two groups：Wiltse approach group（25 cases）and conventional approach group（22 cases）. All these cases were operated with pedicle screw location and fixation. Clinical indexes such as operating time,volume of blood loss,volume of postoperative drainage, Visual Analogue Scale/Score（ VAS）scores of back pain,Cobb angle of injured cord were compared between these two groups. Creatine kinase （ CK）,as a biomarker of muscle injury had also been measured. MRI scores after operation were observed to access the status of muscle infiltrated by fat. Results There was no significant difference in vertebral Cobb angle in the rate of correct comparison（ P ﹥0. 05）. Operating time,intraoperative blood volume loss in patients with wound,postoperative drainage tube drainage measure,VAS low back pain scores in patients of Wiltse group were lower than those of traditional posterior midline approach group,and the difference was statistically significant（ P ﹤0. 05）. The value of CK and MRI at 1 year in Wiltse group was also significantly lower than that of traditional posterior midline approach group,and the difference was statistical significant（ P ﹤0. 05）. Conclusion The treatment of thoracolumbar fracture with Wiltse approach can achieve the same reduction with postmiddle approach,and it has advantages of minimally invasive,less blood loss,simple operation and rapid recovery,and it is worthy to be popularized.