经Wiltse入路与传统后正中入路行切开复位内固定治疗胸腰椎椎体骨折的疗效对比研究

目的 探讨经Wiltse入路与传统后正中入路行切开复位内固定治疗胸腰椎椎体骨折的疗效对比.方法 选择接诊的80例腰胸椎椎体骨折患者,通过随机数表法分为观察组(40例)和对照组(40例).观察组行经Wiltse入路,对照组行传统后正中入路.比较2组患者围术期情况及在不同时间段影像学指标及VAS评分变化、并记录末次随访时0 DI评分.结果 观察组在切口长度、手术时间短于对照组,术中出血量、术后引流量均少于对照组;2组患者在在治疗前、后、内固定取出前、末次随访时伤锥前缘高度、后凸Cobb角相比较均无显著差异(P>0.05);观察组在术后1周、1月、6月、末次随访时,VAS评分均比对照组低(P<0.05);在末次随访时,2组患者ODI评分无显著差异(P>0.05).结论 在腰胸椎椎体骨折患者中行经Wiltse入路给患者带来的创伤小,手术切口小,出血量少,手术时间短,且疼痛感轻,效果优异,值得应用推广.

Comparison of clinical effects of open reduction and intre nal fixation via Wiltse approach or via traditional posterior median approach in treatment of thoracolumbar vertebral fracture

Objective To investigate and compare the clinical effects of open reduction and internal fixation via Wiltse approach or via traditional posterior median approach in treatment of thoracolumbar vertebral fracture .Methods Eighty patients with thoracolumbar vertebral fracture who were admitted and treated in our hospital from March 2014 to March 2015 were randomly divided into observation group ( n =40) and control groups ( n =40).The patients in observation group were treated by open reduction and internal fixation via Wiltse approach ,however ,the patients in control group were treated by open reduction and internal fixation via traditional posterior median approach .The changes of imaging indexes and VAS score in different time points at perioperative period were observed and compared between two groups , moreover , the ODI score was recorded at the end of follow up .Results The length of incision and operation time in observation group were shorter than those in control group ,moreover, the intraoperative hemorrhage volume and postoperative drainage volume were less than those in control group .However there were no significant differences in anterior and posterior height of injuried pyramid and convex Cobb angle before and after treatment between two groups ( P >0.05).The VAS scores on 1w,1m,6m and last follow-up after operation in observation group were significantly lower than those in control group ( P <0.05), but there were no significant differences in ODI scores in last follow-up between two groups ( P >0.05).Conclusion The open reduction and internal fixation via Wiltse approach in treatment of thoracolumbar vertebral fracture has the advantages with less trauma , small incision,less bleeding volume,shorter operation time,less pain,satisfactory therapeutic effects, thus,which is worth using widely in clinical practice .