长臂单轴椎弓根螺钉经Wistle入路与AF系统传统后路复位固定治疗胸腰椎椎体压缩性骨折的对比

Long-arm uniaxial screws through Wistle approach versus AF system through conventional approach in the treatment of thoracic and lumbar compressive fractures

背景:随着治疗理念的进步,减少医源性损伤逐渐得到大家的重视。目前AF系统逐渐退出市场,对于胸腰椎压缩性骨折的手术治疗需要新的内固定器械及入路选择。目的:对比分析长臂单轴椎弓根螺钉经Wistle入路与AF系统内固定传统后入路治疗胸腰椎椎体压缩性骨折的疗效。方法:自2011年3月至2016年12月天津市第三中心医院以长臂单轴椎弓根螺钉经Wistle入路治疗胸腰椎骨折的患者55例(Wistle入路组),以既往2006年1月至2011年1月因胸腰椎骨折行后路传统AF内固定的85例患者为对照(传统入路组),以2组的手术时间、术中出血量、术后引流量、术前术后疼痛目测类比评分、椎体高度矫正率、术后3个月Oswestry功能障碍指数为临床评估指标,行独立样本t检验。结果与结论:(1)2组随访期间未发现断钉、断棒现象;(2)与传统入路组相比,Wistle入路组在手术时间、术中出血量、术后引流量、术后1,3 d目测类比评分等方面有显著优势(P <0.05);在术前目测类比评分、椎体高度矫正率、术后3个月Oswestry功能障碍指数方面2组差异无显著性意义;(3)提示与AF系统传统入路相比,长臂单轴椎弓根螺钉经Wistle入路在保证修复效果的基础上最大程度保留了脊柱后方原始解剖结构的完整性,减少了手术的医源性损伤,对于单纯胸腰椎骨折、未合并神经症状的患者,长臂单轴椎弓根螺钉经Wistle入路是一种更好的修复方式。

BACKGROUND:With the improvement of the concept of treatment,the reduction of iatrogenic injury has gradually been paid much attention.At present,the AF system is gradually withdrawing from the market.The surgical treatment of thoracic and lumbar spine fractures requires new internal fixations and operative approach.OBJECTIVE:To evaluate the treatment outcomes of long-arm uniaxial screws through Wistle approach versus AF system through the conventional approach for thoracic and lumbar compressive fractures.METHODS:From March 2011 to December 2016,55 patients with thoracic and lumbar spine fractures treated with long-arm uniaxial screws through Wistle approach were served as Wistle approach,and 85 cases treated with AF system through the conventional approach from January 2006 to January 2011 were served as control group.The operation time,intraoperative blood loss,postoperative drainage,preoperative and postoperative Visual Analogue Scale scores,vertebral height correction rate,and Oswestry Disability Index scores at 3 months postoperatively were compared by independent-samples t test.RESULTS AND CONCLUSION:(1)There was none of nail/rod broken in each group.(2)The Wistle approach group was significantly advantageous in the operation time,intraoperative blood loss,postoperative drainage and Visual Analogue Scale scores at 1 and 3 days postoperatively compared with the control group(P<0.05).The preoperative Visual Analogue Scale scores,vertebral height correction rate,and Oswestry Disability Index scores at 3 months postoperatively did not differ significantly between two groups.(3)Compared with the AF system through the conventional approach,long-arm uniaxial screws through Wistle approach can retain the posterior ligament complex,is an effective and minimally invasive treatment and can reduce the iatrogenic injury,which is an appropriate repair method for the patients with simple thoracic and lumbar fractures without neurologic symptoms.