Wiltse椎旁肌间隙入路与后正中入路治疗胸腰椎爆裂性骨折:一项前瞻性随机对照试验

目的 比较Wiltse椎旁肌间隙入路和后正中入路治疗胸腰椎爆裂性骨折(TLBF)的临床效果.方法 选择2012年6月至2017年12月在我院接受治疗的152例创伤性单节段TLBF(T11～L4)患者为研究对象,按照单双数随机法将其分为两组,剔除失访患者后,A组62例,B组70例.A组行Wiltse椎旁肌间隙入路手术治疗...

Wiltse paraspinal muscle gap approach and posterior median approach for thoracolumbar burst fracture:a prospective randomized controlled trial

Objective To compare the clinical effects of Wiltse paraspinal muscle gap approach and posterior median approach in the treatment of thoracolumbar burst fracture(TLBF).Methods One hundred and fifty-two patients with traumatic single level TLBF(T11-L4)who received treatment in our hospital from June 2012 to December 2017 were selected as the research objects.The patients were divided into two groups according to the single and even random number method.After excluding the lost follow-up patients,there were 62 cases in group A and 70 cases in group B.The group A was treated by Wiltse paraspinal muscle gap approach,and the group B was treated by posterior median approach.The follow-up results,kyphosis angles,scores of VAS and ODI at different time after operation were compared between the two groups.Results The operation time and X-ray exposure time of the group A were longer than those of the group B,and the intraoperative blood loss volume and postoperative drainage volume of the group A were less than those of the group B(P<0.05);there were no significant differences in ASIA injury grade,incidences of superficial and deep infection of operation site,loosening and fracture of internal fixation between the two groups(P>0.05).The kyphosis angles of the two groups at 1,3,6 month and 1,2 year after operation significantly decreased compared with those before operation(P<0.05),but there were no significant differences between the two groups(P>0.05).The VAS score of the group A was higher than that of the group B at 7 d after operation,and that at 1,3 and 6 month after operation were lower than the group B(P<0.05);there was no significant difference in VAS score between the two groups at 1 year after operation(P>0.05).The ODI scores at 7 d and 1 month after operation in the group A were lower than those in the group B,and the ODI scores at 6 months and 1 year after operation in the group A were higher than those in the group B(P<0.05);there was no significant difference in ODI score between the two groups at 3 months after operation(P>0.05).Conclusion Compared with the posterior median approach,the Wiltse paraspinal muscle gap approach applied in TLBF surgery has more advantages in pain relief,function improvement,reducing intraoperative blood loss and postoperative drainage volume.