经Wiltse肌间隙入路椎弓根内固定术治疗老年胸腰椎骨折效果评价

Evaluation of pedicle screw fixation for the treatment of thoracolumbar fractures through Wiltse paraspinal approach in the elderly

目的评价经Wiltse肌间隙入路椎弓根内固定术治疗老年胸腰椎骨折的临床效果。方法选取2012年8月~2015年3月诊断为胸腰椎骨折的老年患者68例作为研究对象。根据手术方法的不同,将患者分为观察组和对照组,每组各34例。观察组男性21例,女性13例;平均年龄（54.3±8.4）岁。对照组男性20例,女性14例;平均年龄（52.8±9.1）岁。观察组经Wiltse肌间隙入路,对照组经后路入路。比较两组患者的手术时间、术中出血量、术后引流量、术后康复时间、Cobb’s角、椎体前缘高度以及疼痛视觉摸拟量表（VAS）评分、日本骨科协会（JOA）评分。结果观察组各项手术指标优于对照组,差异具有统计学意义（P〈0.05）;两组术后的Cobb’s角和椎体前缘高度较术前均有明显改善,差异具有统计学意义（P〈0.05）,但术后两组组间比较无统计学差异（P〉0.05）;两组术后VAS评分及JOA评分较术前均有改善,差异具有统计学意义（P〈0.05）,且观察组患者术后的VAS评分（3.21±0.62）分优于对照组患者的（4.83±0.86）分;其术后的JOA评分（19.3±8.3）分也优于对照组的（14.3±7.2）分。结论经Wiltse肌间隙入路椎弓根内固定术治疗老年胸腰椎骨折具有较好的效果,患者术后疼痛减轻,恢复良好,值得临床推广。

Objective To evaluate the clinical effect of pedicle screw fixation for the treatment of thoracolumbar fractures in the elderly through Wiltse paraspinal approach. Methods From Aug. 2012 to Mar. 2015,68 elderly patients with thoracolumbar fractures were treated with pedicle screw fixation. The patients were randomly divided into two groups. Thirty-four patients were treated through the Wiltse paraspinal approach [observation group,21 were male and 13 were female with an awerage of（ 54. 3 ± 8. 4） years]and the other 34 patients were treated through traditional approach[control group,20 were male and 14 were female with an average of（ 52. 8 ± 9. 1）years]. The two groups were compared in such parameters as operative time,blood loss,drainage volume,postoperative VAS score,Cobb＇s angle and postoperative JOA score. Results Operative time,peri-operative blood loss volume,postoperative drainage volume and hospital stay in the observation group were significantly less than those in the control group（ P 0. 05）. Postoperative anterior border of vertebral body height and Cobb＇s angle were significantly improved in the two groups（ P 0. 05）,but there was no significant difference in degree of improvement between the two groups（ P 0. 05）. The postoperative VAS score and JOA scores were improved compared with preoperatively,and VAS and JOA score in the observation group were significantly better than those in the control group,and the difference was significant（ P 0. 05）. Conclusion Pedicle screw fixation combined with transpedicular interbody bone grafting through Wiltse paraspinal approach is an effective method in treating thoracolumbar fractures. Compared with traditional approaches,it has more advantages such as less myalgia resulting from paraspinal muscle dissection,less intraoperative injuries,and shorter recovery time. It is worth wide clinical application.