Wiltse入路联合上终板复位置钉三平面固定治疗胸腰椎骨折

Treatment of thoracolumbar fractures by superior endplate bone reduction and screw placement with three planes fixation through Wiltse approach

目的探讨Wiltse入路联合上终板复位置钉三平面固定治疗胸腰椎骨折的临床疗效。方法回顾性分析荆州市第二人民医院2013年1月至2016年1月收治的19例无神经损伤症状胸腰椎单节段骨折患者的临床资料,所有患者均采用Wiltse入路上终板复位技术经伤椎置钉三平面固定(伤椎上位椎体使用单向钉,伤椎及伤椎下位椎体均使用万向钉,上、下位椎体矢状位置钉平行于终板方向,而伤椎矢状面置钉方向在保证不穿透下方终板情况下尽量尾倾)。通过观察手术前后椎体前缘高度比、伤椎后凸角变化,以及随访期间伤椎矫正丢失情况来评价手术疗效。结果术后骨折椎体均获得良好复位。随访8~15个月(平均11.2个月)。术前、术后及末次随访椎体前缘高度比和伤椎后凸角分别是(69.6±2.6)%、(97.9±1.7)%、(95.6±2.3)%和(18.3±0.9)°、(3.9±0.9)°、(4.1±0.3)°,手术前后比较,差异有统计学意义(P<0.05);随访期间复查X线片未见矫正角度丢失。结论 Wiltse入路联合上终板复位置钉三平面固定有利于恢复胸腰椎骨折椎体高度,改善后凸畸形,近期疗效满意。

Objective To explore the clinical effect of superior endplate bone reduction and screw placement with three planes fixation through Wiltse approach in the treatment of thoracolumbar fractures.Methods Clinical data of 19 patients suffered from single segment thoracolumbar fracture without neurological symptoms and treated in the Second People's Hospital of Jiangzhou from January 2013 to January 2016,were retrospectively analyzed.All patients underwent superior endplate bone reduction and screw placement with three planes fixation through Wiltse approach(ie.,use unidirectional nail at the upper vertebra of injured one,and universal nails at the injured vertebra and its inferior one;For the upper and inferior vertebrae,the direction of the sagittal nail should be parallel to the end plate,while the sagittal nail placement direction for the injured vertebra should be as far as possible under the premise of ensuring that it would not penetrate the inferior endplate).The surgical effects were evaluated by changes between preoperative and postoperative anterior vertebral height ratio and vertebral kyphotic angle,as well as the corrective angle loss of fractured vertebra during the follow-up.Results After the operation,the fractured vertebrae were all reduced well.The follow-up time was 8 to 15 months,with an average of 11.2 months.Anterior vertebral height ratio and the vertebral kyphotic angle at preoperation,postoperation and the last follow-up were(69.6±2.6)%,(97.9±1.7)%,(95.6±2.3)%and(18.3±0.9)°,(3.9±0.9)°,(4.1±0.3)°respectively,showed statistical differences between preoperation and postoperation(P<0.05).No corrective angle loss was found in X-ray examination during the follow-up.Conclusion For thoracolumbar fractures,superior endplate bone reduction and screw placement with three planes fixation through Wiltse approach is helpful to restore the vertebral height,improve the kyphosis deformity,and could obtain short-term satisfactory effect.