Wiltse入路联合经椎弓根植骨治疗胸腰段椎体爆裂性骨折的疗效分析

Analysis of the curative effect of bone grafting via the Wiltse approach combined with vertebral pedicle on the treatment of thoracolumbar blowout fracture

目的 比较经Wiltse入路联合椎弓根植骨与传统腰椎后路在治疗胸腰段椎体爆裂性骨折上的治疗效果.方法 2006年4月-2013年4月,于我院治疗需要手术且不需后路减压的单一节段胸腰段椎体爆裂性骨折患者共63例,其中男32例,女31例,平均年龄38岁.患者随机分为3组（n=21）：经Wiltse入路组并经椎弓根植骨组、传统后正中入路经椎弓根值骨组、传统后正中入路未经椎弓根值骨组,分析比较手术耗时、术中出血量、手术前后脊柱Cobb角度改变,术后视觉疼痛模拟评分（VAS）以及末次随访JOA评分.结果 术后对所有患者均进行随访,随访时间6～56个月,平均25个月.手术时间、术后Cobb角矫正率3组间差异无统计学意义（P＞0.05）;Wiltse入路组1在术中出血量及术后引流量上明显少于另外2组,且术后VAS评分、末次随访JOA评分优于其他2组（P＜0.05）.末次随访Cobb角丢失率植骨组低于未植骨组（P＜0.05）.结论 Wiltse入路经肌间隙可直接到达椎体关节突,在治疗不需减压的胸腰椎骨折上,可减少椎旁肌剥离引起的肌肉疼痛,减少术中损伤,加快术后恢复,提高患者术后生活质量.经椎弓根植骨,可提高患者伤椎椎体愈合后强度及稳定性,可防止远期出现胸腰椎后凸畸形.

Objective To compare the therapeutic effects of bone grafting via the Wiltse approach combined with vertebral pedicle with that via the traditional posterior lumbar on the treatment of thoracolumbar blowout fracture. Meth ods Sixty three patients （32 men and 31 women, with an average age of 38 years ） were included into the cmTent study, who required surgery due to thoracolumbar blowout fracture without posterior decompression and admitted into our hospital from April 2006 to April 2013. The patients were randomly divided into three groups （ n = 21 ） , depending on bone grafting via different approaches, namely the Wihse approach combined with vertebral pedicle, traditional posterior lumbar combined with vertebral pedicle and traditional posterior lumbar without combination with vertebral pedicle. Then the data of duration of operation, volumes of bleeding, the postoperative correction rate of Cobb＇s angle before and after operation, the scores of visual analogue scale （VAS） after operation, the scores of Japanese Orthopaedic Association （JOA） inth~ last follow up were analyzed. Results All the patients were followed up six to fifty six months after surgery （twenty five months in average）. No statistical difference was found in the duration of operation, and the post operative correction rate of Cobb＇s angle among three groups （P 〉 0.05 ）. The Wiltse approach group presented obviously less volumes of bleeding and postoperative volumes of drainage than those of other two groups, but better VAS scores, JOA scores and the postoperative correction rate of Cobb＇s angle in the latest follow up （P 〈 0.05 ）. Conclusions The Wihse approach can direct reach the vertebral articular processes which reduce the pain induced by paraspinal muscle dissection during the treatment of thoracolumbar fracture without posterior decompression. It can decrease intraoperative injuries, accelerate recovery and improve the quality of life. Bone grafting via the Approach combined with vertebral pedicle can improve the strength and stability of injured posterior vertebral to prevent thoracolumbar kyphosis in the future.