Wiltse肌间隙入路结合伤椎置钉治疗胸腰椎骨折的疗效分析

目的　探讨经Wiltse肌间隙入路结合伤椎置钉治疗胸腰椎骨折的临床效果。 方法　纳入2015年10月至2018年10月我科收治的胸腰椎骨折患者53例，按手术入路分为Wiltse肌间隙入路组（A组，28例）和传统后正中入路组（B组，26例）。患者Frankel分级为E级，无需椎管减压和植骨融合。A组采用Wiltse肌间隙入路手术，B组采用传统后路手术治疗。观察两组手术时间、术中出血量、术后引流量、术后下地时间，视觉模拟评分法（VAS）评估疼痛情况，测量伤椎体前缘高度与Cobb角，并进行比较。 结果　所有患者获得随访，时间6~18个月，平均12.5个月。手术时间、术中出血量、术后引流量、术后下地时间等指标A组均优于B组（P<0.05）；两组患者术后3 d、术后1月的VAS评分比较差异有统计学意义（P<0.05）；两组术后伤椎前缘高度、Cobb角比较差异无统计学意义（P>0.05）。 结论　经Wiltse肌间隙入路结合伤椎置钉治疗胸腰椎骨折，操作简单，置钉方便，可减少手术时间及出血量，对椎旁肌影响小，减轻术后腰痛程度，缩短康复时间，具有较高的临床应用价值。

Therapeutic effect of Wiltse muscle interstitial approach combined with vertebral screw placement for the treatment of thoracolumbar fractures

Objective　To investigate the clinical effect of the Wiltse muscle gap approach combined with vertebral screw placement on treating of thoracolumbar fractures.　Methods　53 patients with thoracolumbar fractures were admitted to our department from October 2015 to October 2018, which were divided into a Wiltse muscle gap approach group (group A) and a traditional posterior median group (group B) according to the surgical approach. Based on Frankel Graded to grade E, there was no need for the patients to perform the spinal decompression and bone graft fusion. 28 patients in the group A were treated with Wiltse muscle gap approach, and 26 patients in the group B were treated with conventional posterior surgery. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative ground time were observed. Visual analog scale (VAS) was used to evaluate the pain, and the height of the vertebral body leading edge and Cobb angle were measured and compared.　Results　All patients were followed up for 6 to 18 months, with an average of 12.5 months. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative ground time and other indicators in the group A were better than that of the group B (P<0.05). There was statistical difference in VAS scores between 3 days and 1 month after operation of the two groups (P<0.05). There was no significant difference in the height and Cobb angle between the two groups.　Conclusions　The Wiltse muscle gap approach combined with the vertebral screw placement for the treatment of thoracolumbar fractures is simple to operate and pale the screw, which can reduce the operation time, bleeding volume and the degree of postoperative low back pain, shorten the recovery time, with little effect on the paravertebral muscles and high clinical application value.