经Wiltse入路伤椎植骨并置钉治疗胸腰椎骨折

Treatment of thoracolnmbar fractures with Wiltse Approach with transpedicular intervertebral bone graft and pedicle screws fixation in injured vertebrae

目的：探讨1期后路经Wiltse入路伤椎植骨并置钉治疗胸腰椎骨折的临床疗效。方法：2009年2月～2010年1月，对36例胸腰椎椎体骨折经Wiltse入路行椎弓根螺钉内固定、经伤椎一侧椎弓根进行椎体内植骨并行伤椎置钉治疗。其中男26例，女10例；年龄26～52岁，平均38岁。损伤椎体：T102例，T116例，T1212例，L110例，L26例。骨折根据Denis分类：爆裂型骨折10例，屈曲压缩型骨折26例。按Frankel分级：A级2例，B级4例，C级16例，D级10例，E级4例。从受伤至手术时间为8小时～6天，平均3．8天。在手术前后摄X线片测量骨折椎体相对高度及Cobb角恢复情况，通过Frankel分级评价神经功能改善情况。结果：患者均顺利完成手术，所有手术切口均Ⅰ期愈合。36例获随访，随访时间11～26个月，平均15个月。患者均顺利完成手术，术后切口全部Ⅰ期愈合。术前、术后伤椎椎体相对高度分别为52．8％±13．6％、89．6％±10．3％，术后骨折椎体相对高度较术前恢复明显，差异均有统计学意义（P ＜0．05）；术前、术后Cobb角分别为（19．2±2．3）°、（7．3±1．2）°，术后与术前比较恢复明显，差异均有统计学意义（ P ＜0．01）。通过Frankel分级评价脊髓功能改善情况。结论：经Wiltse入路伤椎椎弓根椎体内植骨并置钉治疗胸腰椎骨折临床疗效满意，重建了椎体高度，增加了脊柱前、中柱的稳定性，具有防止术后椎体高度丢失、减少内固定物松动、断裂等优点。

Objective：To study the effectiveness of wiltse approach with transpedicular intervertebral bone graft and pedicle screws fixa-tion in injured vertebrae for the treatment of thoracolumbar fractures.Methods：Between February 2009 and January 2010, 36 patients with thoracolumbar fractures were treated by posterior short-segment fixation combined with Wiltse approach with transpedicular intervertabral bone graft and pedicle screw fixation in injured vertebrae.There were 26 males and 10 females with a mean age of 38 years （ range, 26-52 years）.The injured vertebrae were located at T10 in 2 case, T11 in 6 cases, T12 in 12cases, L1 in 10 cases, L2 in 6 cases.According to Denis classification, there were 10 cases of burst fractures and 26 cases of compression fractures.The time between injury and operation was 8 hours to 6 days （mean, 3.6 days）.The Xray film was taken to measure the relative height of fractured vertebrae and Cobb angle, and Frankel classification was conducted to evaluate the function recovery of the spinal cord.Results：The operations were performed successful-ly, and incisions healed primarily.All the patients were followed up 11-26 months （mean, 15 months）.The relative height of fractured vertebrae were 52.8% ±13.6%at preoperation, 89.6% ±10.3%at after operation, showing significant differences betweenpreoperation and postoperation （P 〈0.05）, The Cobb angles were （19.2 ±2.3）°, （7.3 ±1.2）°, respectively, showing significant differences be-tween preoperation and postoperation （P 〈0.01）, according to frankel criterion the nerves function recoved in different degrees.Conclu-sion：Treatment of thoracolumbar fractures with wiltse approach and transpedicular intervertebral bone graft and pedicle screw fixation in in-jured vertebrae has satisfactory effectiveness, which could reconstruct vertebral body height, increase the stability of anterior and middle col-umn of the injured vertebrae, and prevent height loss of the injured vertebrae and loosening of instrumentation.