Wiltse肌间隙入路联合伤椎置钉治疗胸腰段骨折

Intrameduilary screw fixation through Wiltse paraspinal approach to treat thoracolumbar spine fracture

目的探讨经Wiltse肌间隙入路联合伤椎置钉短节段椎弓根螺钉固定治疗无神经损伤胸腰段骨折的疗效。方法回顾性研究2013年11月至2015年1月采用Wihse肌间隙入路与传统剥离椎旁肌入路分别联合伤椎置钉治疗胸腰段骨折的48例患者资料，Wiltse肌间隙入路的患者为A组（24例），传统剥离椎旁肌入路的患者为B组（24例）。两组患者术前一般资料比较差异无统计学意义（P〉0．05），具有可比性。比较两组患者的手术时间、手术出血量、术后下地时间，术前及术后不同时间点腰背部疼痛视觉模拟评分（VAS），术前、术后下地前和末次随访时伤椎前缘高度比值的变化。结果两组患者均无切口并发症、螺钉松动及断钉发生。A组手术时间、出血量与术后下地时间均少于B组，差异有统计学意义（P〈0．001）。两组患者术后VAS评分均较术前明显恢复，差异有统计学意义（P〈0．05），术后1d、3d、1周、2周VAS评分两组间比较差异均有统计学意义（P〈0．001），A组低于B组；术后6个月VAS评分两组间比较差异无统计学意义（P=0．328）。两组患者术后伤椎前缘高度均较术前明显恢复，差异有统计学意义（P〈0．05）；两组间椎体高度恢复率比较差异无统计学意义（P〉0．05）。结论两种手术入路联合伤椎置钉治疗胸腰段脊柱骨折均能使椎体骨折获得良好复位，但Wiltse肌间隙入路手术时间短、创伤更小、术后恢复更快。

Objective To demonstrate the efficacy of fixation with short-segment thoracolumbar pedicle screws through Wiltse paraspinal approach in treatment of the thoracolumbar spine fracture without neurotrosis. Methods A retrospective analysis was conducted of the 48 patients with thoraeolumbar spine fracture who had undergone intramedullary screw fixation from November 2013 to January 2015. The Wiltse paraspinal approach was adopted in 24 patients （group A）, 12 males and 12 females, with a mean age of 48. 1 ± 8.0 years. The conventional approach was adopted in 24 patients （group B）, 19 males and 5 females, with a mean age of 46.7 ± 13.1 years. The 2 groups were compatible in preoperative demographic data （ P 〉 0.05） . Operation time, blood loss, time for ambulation, visual analogue scale （VAS） scores for the waist pain pre- and post-operation, and recovery rates of anterior vertebral height pre-operation, post-operation but pre-ambulation and at the last follow-up were compared between the 2 groups. Results No incision infection or implant failure occurred in either group. The operation time, blood loss and time for ambulation in group A were significantly less than in group B （ P 〈 0. 001 ） . The post-operative VAS scores were significantly lower in both groups than the preoperative ones （ P 〈 0. 05）. There were significant differences between the 2 groups in the VAS scores at 1 day, 3 days, 1 week and 2 weeks post-operation （ P 〈 0. 001）, but none in the VAS score at 6 months post-operation （ P = 0. 328）. Compared with pre-operation, the anterior verte- bral heights were significantly recovered in both groups post-operation （ P 〈 0. 05）, but there were no significant differences between the 2 groups in the recovery rates of anterior vertebral height（ P 〉 0.05） . Conclusion Although intramedullary screw fixation through both approaches can lead to favorable reduction, the Wiltse paraspinal approach can result in shorter operation time, less operative trauma, and quicker recovery.