经Wiltse肌间隙入路内固定结合椎体内植骨治疗胸腰椎骨折的早期疗效观察

背景：随着微创脊柱外科技术的发展和对椎旁肌功能的重视，经Wiltse肌间隙入路内固定技术逐步、广泛应用于胸腰椎骨折的治疗。目的：探讨经Wiltse肌间隙入路内固定结合椎体内植骨治疗胸腰椎骨折的早期疗效和临床应用价值。方法：本研究纳入2009年5月至2011年5月收治的行单节段椎弓根螺钉内固定结合椎体内植骨术的患者46例。术前脊髓损伤（American Spinal Injury Association, ASIA）分级均为E级，胸腰椎损伤分类及损伤程度评分系统（thoracolum- bar injury classification and severity score, TLICS）评分均大于4分。根据随机原则分组，23例采用Wiltse肌间隙入路治疗（A组），另外23例采用传统后正中入路治疗（B组）。观察两组围手术期的手术时间、术中出血量、术后引流量及术后住院时间，术后视觉模拟量表（visualanaloguescale，VAS）评估疼痛情况，影像学测量x线侧位片上后凸角与椎体前缘高度，并进行比较分析。结果：所有患者均获得随访，时间12～18个月，平均（15．3±2．6）个月。手术时间、术中出血量术后引流量及术后住院时间A组明显少于B组（P〈0．05）。术后疼痛VAS评分A组明显低于B组（P〈0．05），但末次随访时两组趋于一致，无明显统计学差异。两组方法术后均能明显矫正后凸角和椎体前缘高度，但随访时均有丢失（P〈0．05）。术前椎体压缩程度和术后矫正度两组差异无统计学意义，且随访两组后凸角矫形丢失及椎体前缘高度矫正丢失差异无统计学意义（P〉0．05）。结论：经Wiltse肌间隙入路内固定结合椎体内植骨是治疗胸腰椎骨折的有效方法，操作简单，置钉容易，同时能有效恢复椎体高度和纠正后凸角度，与传统后正中入路相比，明显减少了手术时间、手术创伤与出血，减轻了腰背疼痛。

Preliminary curative effect of pedicle screw fixation combined with transpedicular interbody bone grafting for the treatment of throacolumbar fractures through Wiltse paraspinal approach

ackground： With the development of minimally invasive spinal technique and the attention of paraspinal muscle function, Wiltse paraspinal approach has been widely used in the treatment of thoracolumbar fractures. Objective： To investigate the clinical outcome of pedicle screw fixation combined with transpedieular interbody bone graft- ing for the treatment of the throacolumbar fractures through Wiltse paraspinal approach. Methods： From May 2009 to May 2011, 46 patients with thoracolumbar fractures were treated with single-segment pedicle screw fixation combined with transpedicular interbody bone grafting. Based on American Spinal Injury Association （ASIA） spinal cord injury grade, the whole patients were in grade E before treatment. The thoracolumbar injury classification and se- verity score （TLICS） in all the patients were greater than 4. The patients were randomly divided into two groups. 23 patients were treated through the Wiltse paraspinal approach （group A）. and another 23 patients were treated through traditional ap- proach （group B）. Operative time, perioperative blood loss volume, postoperative drainage volume and hospital stay were compared between two groups. The visual analogue scale （VAS） was used after operation. The anterior border of vertebral body height and posterior salient were measured by X-ray lateral projection. Results： All patients were followed up from 12 to 18 months with an average of （15.3±2.6） months. Operative time, periop-erative blood loss volume, postoperative drainage volume and hospital stay and VAS of back pain in group A were signifi- cantly less than those in group B （P〈0.05）. There was no significant diference in VAS between the two groups at the final follow-up. Postoperative anterior border of vertebral body height and posterior salient were significantly improved in two groups （P〈0.05）, but there was no significant difference in degree of improvement between two groups （/：＇〉0.05）. Angle and height loss existed at the final follow-up （P〈0.05）, but there was no significant difference in loss of anterior border of verte- bral body height and posterior salient between two groups （P〉0.05）. Conclusions： Pedicle screw fixation combined with transpedicular interbody bone grafting through Wiltse paraspinal ap- proach is an effective method in treating thoracolumbar fractures. The method has advantages of simple operation and easy establishing screw. It can effectively rebuild the height of vertebral body and rectify posterior salient. Compared with the tra- ditional operative method, it can obviously reduce the operative time, operation wound and bleeding, and lessen the pain of lumbar and back.