Wiltse入路结合非融合技术治疗胸腰椎骨折疗效分析

EFFECTIVENESS OF PEDICLE SCREW FIXATION COMBINED WITH NON-FUSION TECHNOLOGY FOR TREATMENT OF THORACOLUMBAR FRACTURE THROUGH Wiltse PARASPINAL APPROACH

目的探讨经Wiltse入路结合非融合技术治疗AO分型为A型的胸腰椎骨折疗效。方法2011年3月-2012年12月，采用Wiltse入路钉棒系统复位固定结合非融合技术治疗胸腰椎骨折35例。男27例，女8例：年龄19～51岁，平均39．7岁。致伤原因：交通事故伤17例，高处坠落伤11例，重物压砸伤7例。骨折节段分别为T8 1例，T9 2例，T10 2例，T11 3例，T12 12例，L1 10例，L2 4例，L3 1例。骨折按AO分型：A1型（压缩型骨折）17例，A2型（劈裂型骨折）3例，A3型（爆裂型骨折）15例。术前神经功能按美国脊髓损伤协会（ASIA）分级均为E级。受伤至手术时间3～15d，平均5．9d。记录并分析围手术期指标，测量椎体前缘高度和后凸Cobb角评价矫正效果。结果手术时间平均74min，术中出血量平均125mL，术后引流量平均51mL。术后2例出现切口皮肤坏死，经换药后延期愈合；余切口均Ⅰ期愈合。35例均获随访，随访时间15～24个月，平均17-3个月。随访期间无内固定物松动及断裂等并发症发生。术后12～19个月，平均15个月取出内固定物。术后即刻、内固定物取出前及末次随访时椎体前缘高度及后凸Cobb角均较术前显著改善（P〈0．05）：术后各时间点间椎体前缘高度比较，差异无统计学意义（P〉0．05）；术后即刻后凸Cobb角与内固定物取出前及末次随访时比较，差异有统计学意义（P〈0．05），内固定物取出前与末次随访比较差异无统计学意义（P〉0．05）。内固定物取出后伤椎屈伸活动范围均恢复。结论Wiltse入路结合非融合技术治疗AO分型为A型的胸腰椎骨折手术操作简便、创伤小，可有效恢复椎体高度和矫正后凸畸形。

Objective To explore the effectiveness of pedicle screw fixation combined with non-fusion technology for the treatment of thoracolumbar fracture （AO type A） through Wiltse paraspinal approach. Methods Between March 2011 and December 2012, 35 cases of thoracolumbar fractures were treated with pedicle screw fixation combined with non- fusion technology by Wiltse paraspinal approach. There were 27 males and 8 females, aged from 19 to 51 years （mean, 39.7 years）. The time from injury to operation varied from 3 to 15 days （mean, 5.9 days）. The causes of injury were traffic accident in 17 cases, falling from height in 11 cases, and crush trauma in 7 cases. All fractures were single-segment fracture, including T8 in 1 case, T9 in 2 cases, T10 in 2 cases, T11 in 3 cases, T12 in 12 cases, L1 in 10 cases, L2 in 4 cases, and L3 in 1 case. According to AO classification, there were 17 type A1 fractures （compression fracture）, 3 type A2 fractures （splitting fracture）, and 15 type A3 fractures （burst fracture）. Based on American Spinal Injury Association （ASIA） spinal cord injury grade, all cases were in grade E before operation. Perioperative parameters were recorded; the anterior vertebral height and kyphotic Cobb angle of vertebral bodies were measured before and after operation to evaluate the effect of correction. Results The mean operating time was 74 minutes; the mean blood loss was 125 mL; and the mean drainage volume was 51 mL. Skin necrosis of incision occurred in 2 cases and was cured after dressing change; primary healing of incision was obtained inthe others. All patients were followed up 15-24 months （mean, 17.3 months）. No loosening or breakage of internal fixation was found. The internal fixator was removed at 12-19 months after operation （mean, 15 months）. There were significant differences in Cobb＇s angle and anterior vertebral body height between before operation and immediately after operation, before internal fixator removal as well as at last follow- up （P 〈 0.05）. There was no significant difference in anterior vertebral body height among the postoperative time points （P 〉 0.05）. There was significant difference in Cobb＇s angle between immediately after operation and before internal fixator removal as well as at last follow-up （P 〈 0.05）, but the difference was not significant between before internal fixator removal and at last follow-up （P 〉 0.05）. The motion of fixed segment was restored after internal fixator removal. Conclusion It is an effectivemethod of pedicle screw fixation combined with non-fusion technology through Wiltse paraspinal approach for the treatment of thoracolumbar fracture （AO type A）. The method has the advantagesof simple operation and less trauma. It can effectively rebuild the height of vertebral body and correct kyphotic deformity.