经Wiltse肌间隙入路与后正中入路治疗胸腰椎骨折患者的临床对比研究

Clinical comparative study of Wiltse muscle gap approach and posterior median approach in treatment of thoracolumbar vertebral fracture

目的探讨经Wiltse 肌间隙入路内固定与后正中入路治疗胸腰椎骨折患者的临床疗效对比.方法：本研究纳入2012 年1 月至2014 年1 月收治的无脊髓神经损伤、无需椎管减压、行单节段椎弓根螺钉内固定结合椎体内植骨术的患者40 例,按照治疗方法分为A 组和B 组,每组各20 例.A 组患者采用Wiltse 肌间隙入路治疗;B 组患者采用后正中入路治疗.观察两组患者手术中出血量、术后引流量,术后视觉模拟量表（Visual Analogue Scale/ Score, 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8-14 个月,平均（11. 1±2. 7）个月.术中出血量、术后引流量、术后疼痛VAS 评分,A 组患者明显优于B 组（P〈0. 05）.两组患者术后均能明显矫正后凸角和椎体前缘高度.结论：经Wiltse 肌间隙入路内固定治疗胸腰椎骨折患者,能有效恢复椎体高度和纠正后凸角度（Coob 角）,明显减少患者手术出血,减轻术后腰背部疼痛,临床效果优于传统后正中入路组,是符合现代骨科微创理念的一种手术方式.

Objective:To investigate and compare clinical curative effects of Wiltse muscle gap internal fixation approach and posterior median approach in treatment of thoracolumbar vertebral fracture. Methods:40 cases without spinal cord or nerve injury, no need vertebral canal decompression, and undergoing single segment pedicle screw internal fixation combined with vertebral body graft bone surgery from January 2012 to January 2014 were included in this study, and divided into group A and group B according to the treatment method, 20 cases in each group. Group A was treated with the Wiltse muscle gap approach, while group B was treated with the posterior median approach. The intraoperative bleeding loss, postoperative drainage volume, and visual analogue scale/score ( VAS) of the two groups were observed. The postoperative kyphosis angle and vertebral anterior edge height of the two groups were measured by lateral X ray and comparatively analyzed. Results: All patients were followed up for 8 to 14 months, average (11. 1± 2. 7) months. The intraoperative bleeding loss, postoperative drainage volume, and postoperative pain VAS score of group A was sig-nificantly better than those of group B (P<0. 05). The two groups were significantly improved in the postoperative kyphosis angle and vertebral height. Conclusions:The Wiltse muscle gap internal fixation approach in the treatment of thoracolumbar vertebral fracture can effectively restore the vertebral height and correct kyphosis ( Coob) angle, significantly reduce intraoperative bleeding loss, allevi-ate postoperative pain in the waist and back, has better clinical effects than the traditional posterior median approach, and is in line with the concept of minimally invasive surgery.