经Wiltse入路结合伤椎置钉椎体内植骨治疗无神经症状的胸腰椎骨折疗效观察

The observation of curative effect of Wiltse approach combined with intravertebral bone grafting for thoracolumbar fractures without neurological symptoms

目的探讨经Wiltse入路结合伤椎置钉椎体内植骨治疗无神经症状的胸腰椎骨折的临床疗效。方法 2013年3月—2016年8月北大医疗鲁中医院收治30例胸腰椎骨折患者,其中男性12例,女性18例;年龄55～72岁,平均65. 4岁。致伤原因:高处坠落伤12例,道路交通伤10例,摔伤8例。受伤至手术时间2～7d,平均2. 8d。患者术前均无明显神经症状,均采用经Wiltse入路结合伤椎置钉椎体内植骨治疗。观察术前及术后VAS评分、伤椎Cobb角、椎体前后缘高度改善情况。结果患者术后平均随访14. 0个月。术后1、12个月VAS评分、后凸Cobb角及伤椎前后缘高度均较术前显著改善,差异有统计学意义(P <0. 05);术后6、12个月后凸Cobb角及伤椎前后缘高度比较差异无统计学意义(P> 0. 05),疼痛明显缓解,椎体高度无丢失。结论经Wiltse入路结合伤椎置钉椎体内植骨治疗无神经症状的胸腰椎骨折,符合"微创"手术操作原则,创伤小、术后恢复快,可有效恢复伤椎的生物力学性能,明显降低患者术后并发症发生率。

Objective To investigate the clinical effect of Wiltse approach combined with intravertebral bone grafting for thoracolumbar fractures without neurological symptoms. Methods From Mar. 2013 to Aug. 2016,30 cases of thoracolumbar vertebral fractures were treated in PKUCare Luzhong Hospital. There were 12 males and 18 females,aged 55-72 years,with an average age of 65.4 years. The causes of injury were 12 cases of high falling injuries,10 cases of road traffic injuries and 8 cases of accidental falls. Operations were carried out 2-7d after injury,with an average of 2.8d. All patients had no obvious neurological symptoms before operation,and were treated with Wiltse approach combined with screw placement and bone grafting in the vertebral body. The visual analogue score （VAS）,the Cobb angle of the injured vertebrae and the height of the anterior and posterior edge of the vertebral body were observed before and after operation. Results All patients were followed up for 14.0 months. VAS score,kyphotic Cobb angle and the height of anterior and posterior margins of injured vertebrae were significantly improved at 1 month and 12 months after operation（ P 〈0.05）,and there was no significant difference between the two groups at 6 months and 12 months after operation in kyphotic Cobb angle and the height of anterior and posterior margins of injured vertebrae （ P 〉 0.05）. Pain was relieved without any loss of vertebrae height. Conclusion The treatment of thoracolumbar vertebral fractures without neurological symptoms by Wiltse approach combined with intravertebral bone grafting is in accordance with the principle of “minimally invasive” operation,with minimal trauma and rapid postoperative recovery,which can effectively restore the biomechanical properties of injured vertebrae and significantly reduce the incidence of postoperative complications.