经Wiltse入路伤椎椎弓根置钉内固定治疗胸腰椎爆裂性骨折的疗效观察

Pedicle screw fixation of injured vertebra in thetreatment of thoracolumbar burst fractures through Wiltse approach

目的：探讨经 Wiltse 入路伤椎椎弓根钉内固定治疗胸腰椎爆裂性骨折的临床疗效。方法选取本科室45例无明显神经损伤且不需要椎管减压的胸腰椎爆裂性骨折患者，随机分为Wiltse入路组（A组，24例）和后正中入路组（B 组，21例），均经伤椎6钉固定，比较两种术式的手术时间、术中出血量、术后引流量、术前术后Cobb角、术前术后椎体前缘高度、术后1周VAS评分。结果术后随访12～20个月，平均16个月，两组术后Cobb角、椎体前缘高度均较术前明显改善（ P＜0．05），两组之间术后各时段Cobb 角、椎体前缘高度比较差异无统计学意义（P＞0．05），A 组在手术时间、术中出血量、术后引流量、术后VAS评分优于B组（ P＜0．05） 。结论经Wiltse入路伤椎椎弓根钉内固定治疗胸腰椎爆裂性骨折，椎旁肌损伤轻、手术创伤小、术后腰背痛缓解快、置钉简单方便等，术后恢复快，疗效好。

Objective To evaluate the clinical effects of pedicle screw fixation of injured vertebra in the treatment of thoracolumbar burst fractures through Wiltse approach. Methods 45 thoracolumbar burst fractures patients those who without obvious nerve injury and without the need of decompression for the spinal canal were randomly divided to Wihse approach （ Group A,24 cases） and posterior midline approach （ Group B,21 cases） , all of the patients received6 - screw treatment in injured vertebra. The operation time, blood loss, postoperative drainage, preoperative and postoperative changes of Cobb angles and fractured vertebralanterior height, postoperative VAS score were observed and compared. Results All the cases were followed up for 12 to 20 months （ 16 months on average）. The anterior vertebra height and Cobb~ angle of the two groups were improved significantly after operation （P 〈 0. 05 ）, but the difference of anterior vertebra height and Cobb~ angle of the two groups were not statistically significant （P 〉 0. 05）. Wiltse approach had obvious advantages in operative time, bloodloss,postoperative drainage and VAS score （P〈 0. 05 ）. Conclusions The Wihse approach has the advantage of less tissue injury, fewer traumas, quick relief of back pain postoperatively, easy for pedicle screw insertion, quicker recoverY and better effect.