正中入路与Wiltse入路减压内固定治疗胸腰椎骨折伴脊髓损伤对比研究

Efficacy comparison of thoracolumbar fractures with spinal cord injury by midline approach and Wiltse approach decompression and internal fixation

目的比较正中入路与Wiltse入路减压内固定治疗胸腰椎骨折伴脊髓损伤的临床疗效。方法选取上海长征医院南京分院自2015年1月至2017年1月收治的140例胸腰椎骨折伴脊髓损伤患者为研究对象。采用随机数字表法将所有患者分为A、B两组,每组各70例。A组采用正中入路;B组采用Wiltse入路。比较两组患者手术及住院指标、Cobb角、视觉模拟疼痛评分(VAS)、Frankel分级以及Oswestry功能障碍指数(ODI)。结果 B组出血量、手术时间、引流量、住院费用、住院时间均显著低于A组(P <0. 05)。B组术后6个月、1年VAS评分显著低于A组(P <0. 05)。B组B、C、D级患者比例评分显著低于A组,E级患者比例高于A组,差异有统计学意义(P <0. 05)。结论正中入路与Wiltse入路减压内固定治疗均能显著降低Cobb角,提升脊椎功能,但Wiltse入路手术创伤小、神经功能恢复更好,更符合微创手术理念。

Objective To compare the efficacy of the thoracolumbar fractures with spinal cord injury by midline approach and Wiltse approach decompression and internal fixation.Methods A retrospective study was performed on 140 cases of patients with thoracolumbar fractures with spinal cord injury who were admitted from January 2015 to January 2017.Patients were randomly divided into the Group A and Group B,with 70 cases in each group.Patients in Group A were adopted the midline approach,the others in Group B were adopted Wiltse approach.The surgical and inpatient indicators,Cobb Angle before and after surgery,pain（VAS）score,Frankel score and dysfunction index （ODI） were compared between the two groups. Results The blood loss,operation time,drainage volume,hospitalization cost and hospitalization time in Group B were significantly lower than those in Group A,and the differences were statistically significant（ P 〈0.05）.The VAS score of Group B was significantly lower than that of Group A at 6 months and 1 year after surgery,and the difference was statistically significant（ P 〈0.05）.ODI score of Group B was significantly lower than that of Group A,and the difference was statistically significant（ P 〈0.05）.The ODI score of Group B was significantly lower than that of Group A,and the difference was statistically significant（ P 〈0.05）.Conclusion Both midline approach and Wiltse approach decompression and internal fixation can reduce the Cobb angle and ameliorate the spinal function,while the Wiltse approach has less surgical trauma,better neurological recovery,and is more in line with the concept of minimally invasive surgery.