经Wiltse入路在胸腰段椎体骨折手术中的应用分析

Application of Wiltse approach to the operation on thoracolumbar vertebral fracture

目的探讨经椎旁肌间隙(Wiltse)入路治疗胸腰段椎体骨折的临床效果。方法对60例胸腰段椎体骨折患者的诊治经过进行回顾性分析,根据治疗方法分为两组,其中采用传统正中入路手术治疗32例(传统组),采用经Wiltse入路治疗28例(Wiltse组)。结果 Wiltse组的手术时间、术中出血量、术后引流量均显著低于传统组(P<0.05)。在术后1 w内,两组的VAS评分较术前均显著降低(P<0.05),且Wiltse组术后24 h和48 h的VAS评分、血肌酸激酶值均显著低于传统组(P<0.05)。手术前后两组JOA评分和Cobb角比较均无统计学差异(P>0.05);术后3、6个月及末次随访,两组的JOA评分、Cobb角与术前比较均有显著改善(P<0.05)。结论经Wiltse入路治疗胸腰段椎体骨折较传统正中入路手术具有手术时间短、出血少、术后恢复快的特点,而疗效与传统正中手术效果相当。

Objective To investigate the clinical effects of treatment via paraspinal muscle gap approach（Wiltse） on patients with thoracolumbar vertebral fracture. Methods Retrospective analysis was made in 60 cases of thoracic lumbar vertebral fracture.According to the treatment methods, those were divided into two groups. The surgery via conventional median approach was carried out in 32 cases（traditional group）, while the treatment via Wiltse approach was carried out in 28 cases（Wiltse group）. Results The operation time, bleeding volume, and postoperative drainage volume in the Wiltse group were significantly shorter or lower than those in the traditional group（P 〈 0.05）. Within one week after the operation, the VAS scores of both groups significantly decreased（P 〈0.05）, and the VAS scores and blood creatine kinase values 24 h and 48 h after the operation in the Wiltse group were significantly lower than those in the traditional group（P 〈 0.05）. There was no significant difference in JOA scores and Cobb scores between the two groups before and after operation（P 〉 0.05）. Those scores of both groups 3 and 6 months after the treatment and at the time of the last follow-up were significantly improved compared with those before the operation（P 〈 0.05）. Conclusion Compared with the operation via conventional median approach, the treatment via Wiltse approach on thoracolumbar vertebral fracture has the advantages of shorter operation time, less bleeding, quick recovery after operation, and the similar curative effects as the conventional way.