不同入路椎弓根钉棒内固定治疗脊柱胸腰段骨折的临床疗效

The clinical efficacy of different approaches of pedicle screw fixation in treatment of thoracolumbar fractures

目的 探讨椎弓根钉棒不同入路方式内固定治疗脊柱胸腰段骨折的临床效果,为临床选择术式提供参考。方法 回顾性分析2010年1月-2013年12月68例后路椎弓根钉棒内固定术式治疗脊柱胸腰段骨折患者临床资料,按术式分为正中入路组及Wiltse入路组,正中入路组34例患者实施传统后正中入路手术,Wiltse入路组34例患者实施Wiltse入路手术。对比两组患者临床指标、影像学表现、肌酸激酶水平及疼痛评分。结果 Wiltse入路组手术时间、出血量、引流量、住院时间均明显低于正中入路组,差异均有统计学意义（P〈0.05）;Wiltse入路组术后1 d、3 d、5 d血清肌酸激酶水平均明显低于正中入路组,差异均有统计学意义（P〈0.05）;两组患者后凸Cobb角、伤椎前缘高度术后及末次随访相比术前两组均有显著改善（P〈0.05）,但两组间术后及末次随访比较差异无统计学意义（P〉0.05）;Wiltse入路组术后1个月、术后6个月VAS评分分别为（2.05±0.41）、（0.69±0.12）分,均明显低于正中入路组,差异均有统计学意义（P〈0.05）。结论 Wiltse入路椎弓根钉棒内固定治疗与传统入路方式治疗骨折效果无明显差异,但Wiltse入路治疗胸腰段骨折操作简便,创伤小,疼痛感低。

Objective To investigate clinical efficacy of different approaches of pedicle screw fixation in treatment of thoracolumbar fractures, to provide a reference for clinical surgery. Methods A retrospective analysis from January 2010 to December 2013 68 thoracolumbar fracture patients were performed, these patients were treated with posterior pedicle screw fixation rod, according to surgical approach they were divided into the middle group and Wiltse approach group, 34 patients in midline approach groupused conventional surgical midline approach, Wiltse approach group 34 patients used embodiment Wiltse approach surgery. Clinical parameters between two groups of patients, imaging findings, creatine kinase levels and pain scores were compared. Results In Wiltse approach group, the operative time,blood loss, drainage, length of hospital stay were significantly lower than the control group, the differences were statistically significant（P〈0.05）; preoperative serum creatine kinase levels of Wiltse approach group showed no difference compared with control group（P〈0.05）, serum creatine kinase levels in Wiltse approach group 1 d, 3 d, 5 d after surgery were significantly lower than the control group, the differences were statistical significant（ P〈0. 05）; for two groups Cobb＇s angle, the leading edge of vertebral height both improved significantly（P〈0.05）, but at the time of the last follow-up, Cobb＇s angle and the leading edge of vertebral height between the two groups showed no significant difference（P〈0.05）; in Wiltse approach group after one month and after six months VAS scores were（2.05 ±0.41）,（0.69±0.12）scores, significantly lower than the control group, the differences were statistically significant（ P〈0.05）. Conclusion Wiltse approach pedicle screw fixation has same effect with the traditional way of treating fractures of thoracolumbar,but Wiltse approach is simple, less invasive, with low pain.