胸腰椎骨折经Wiltse肌间隙入路与传统入路的临床对比研究

Thoracolumbar Fractures by Wiltse Muscular Clearance Clinical Comparative Study Approach and Traditional Approach

目的探讨经Wiltse肌间隙入路内固定与传统入路治疗胸腰椎骨折的临床疗效对比。方法本研究纳入2011年5月至2012年10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（ASIA）分级均为E级,胸腰椎损伤分类及损伤程度评分系统（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）。观察两组手术中出血量、术后引流量,术前及术后1、3、7 d测定肌酸激酶水平,术后视觉模拟量表（visual analogue scale,VAS）等资料,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。结果所有患者均得随访,时间9～14个月,平均（12.5±2.6）个月。术中出血量、术后引流量、术后肌酸激酶水平、术后疼痛VAS评分A组明显少于B组（P〈0.05）。两组方法术后均能明显矫正后凸角和椎体前缘高度。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,能有效恢复椎体高度和纠正后凸角度（cobb角）,且能明显减少手术出血及椎旁肌损伤,减轻了术后腰背部疼痛。

Objective To investigate the clinical outcome of pedicle screw fixation combined with transpedicular interbody bone graftingfor the treatment of the throacolumbar fractures through Wiltse paraspinal approach.Methods This study included in May 2011 to October 2012 were single segmental pedicle screw internal fixation combined with vertebral body bone graft in46 cases of patients.Preoperative Spinal cord Injury（ASIA）class are E,thoracolumbar Injury classification and damage degree evaluation system（TLICS）scores were greater than4 points.According to the principle of random grouping,23 cases with Wiltse muscular clarance into the road treatment（group A）and the other 23 cases with traditional therapy（group B）after the middle of the road.Observe two groups of intraoperative blood loss,postoperative flow,preoperative and postoperative l,3,7 d determination of creatine kinase level,postoperative visual analog scale（VAS）,imaging measurement of the protruding after X ray on a piece of Angle and height,fanterior and comparative analysis.Results All patients were followed up,time 9～14 months,an average（12.5±2.6）months.Intraoperative blood loss,preoperative and postoperative 1,3,7 d determination of creatine kinase level,Postoperative pain VAS score in group A was lower than that in group B（P〈0.05）,Two groups of postoperative method are significantly after correction fanterior edge convex Angle and height,no significant statistical difference.Conclusion Pedicle screw fixation combined with transpedicular interbody bone grafting through Wiltse paraspinal approachis an effective method in treating thoracolumbar fractures..It can effectively rebuild the height of vertebral body and rectify posterior salient.Also,it can obviously reduce the operative time,operation wound and bleeding,and lessen the pain oflumbar and back.