计算机导航下经Wiltse入路钉棒内固定治疗胸腰椎骨折的疗效观察

目的探讨计算机导航辅助下Wiltse入路椎弓根钉棒内固定术治疗胸腰椎骨折的临床疗效及优势。方法回顾性分析2015年7月至2017年6月,我科收治的53例胸腰椎骨折患者,均为单节段骨折。按手术方式分为A组29例和B组24例,A组患者采用计算机导航辅助下Wiltse入路椎弓根钉棒内固定术治疗,B组采用传统后正中入路开放手术。对两组患者术中出血量、术后引流量、置钉准确率、手术前后椎体后凸Cobb角,手术前后VAS评分等指标进行评估。结果两组患者手术时间相差无几,术中出血量、术后引流量A组患者均少于B组患者,差异均有统计学意义(P0.05);患者置钉准确率A组(99.1%)高于B组(87.5%),差异有统计学意义(P0.05);术后24小时及术后3月两组患者伤椎后凸Cobb角比较差异无统计学意义;术后24小时A组VAS评分低于B组,差异有统计学意义(P0.05),术后3月两组比较差异无统计学意义(P0.05)。结论计算机导航辅助下肌间隙入路椎弓根有效钉棒内固定技术治疗胸腰椎骨折疗效满意,能减少手术创伤,降低手术风险。

Effect of internal fixation for the treatment of thoracolumbar fracture guided by computer assisted navigation via Wiltse paraspinal approach

Objective To investigate the clinical outcome of internal fixation for the treatment of thoracolumbar fracture guided by computer assisted navigation via Wiltse paraspinal approach. Methods From July 2015 to June 2017, 53 patients with thoracolumbar fractures were observed. 29 patients (Group A) were treated with internal fixation guided by computer assisted navigation via Wiltse paraspinal approach, while 24 patients (Group B) were treated with internal fixation via conventional operative approach. The operative time, blood loss, drainage volume, the accuracy of transpedicular screw, VAS score and Cobb''s angle were compared between two groups. Results All cases were followed up for 3 months. The operative time was similar between two groups (P>0.05). The blood loss and drainage volume in group A were lower than those in group B (P<0.05). According to the classification of Andrew, pedicle screw positon was evaluated by postoperative CT scan, the accuracy of transpedicular screw in group A was better than that in group B (P<0.05). Cobb''s angle of two groups were obviously corrected after surgery, and there was no significant difference between 2 groups. The VAS score in group A was much lower than that in group B 24h postoperative (P<0.05), while the VAS score was similar 3 months postoperative (P>0.05). Conclusions Compared with conventional operation approach, the internal fixation guided by computer assisted navigation via Wiltse paraspinal approach has such advantages as less surgical trauma and surgical risk on thoracolumbar fracture treating.