Wiltse肌间隙入路在伤椎置钉内固定治疗胸腰椎骨折术中的应用

Application of internal fixation with screws for thoracolumbar fractures through the muscular space approach of Wiltse

目的探讨Wiltse肌间隙入路伤椎置钉内固定治疗胸腰椎骨折的临床疗效。方法回顾性分析2015年4月—2017年1月中国人民解放军第九八医院全军创伤骨科修复重建中心收治的98例胸腰椎骨折合并脊髓损伤单节段胸腰椎骨折患者临床资料,男性57例,女性41例;年龄21~70岁,平均43.6岁。患者均接受后路椎弓根螺钉内固定手术,依据手术入路不同分为Wiltse肌间隙入路(Wiltse组)和传统手术入路(传统组),各49例。记录两组患者术中出血量和时间、术后引流量,术前1d、术后1、12个月、末次随访时分别记录患者VAS评分、ODI指数、后凸Cobb角等指标和并发症情况。结果患者均成功完成手术,随访13~35个月,平均23.1个月;Wiltse组术中出血量(115.61±12.09)mL、术后引流量(68.22±11.03)mL少于传统组(179.09±13.81)mL、(123.94±14.15)mL,差异有统计学意义(P<0.05);Wiltse组手术时间(78.82±7.01)min长于传统组(77.72±7.51)min,差异无统计学意义(P>0.05);末次随访时,Wiltse组患者VAS评分(3.10±1.65)分低于传统组(4.91±1.58)分,Wiltse组患者ODI指数(8.19±2.09)分低于传统组(11.92±2.93)分,差异有统计学意义(P<0.05);Wiltse组患者后凸Cobb角显著小于传统组,差异有统计学意义(P<0.05)。两组患者手术均未发生严重并发症。结论Wiltse肌间隙入路伤椎置钉内固定治疗胸腰椎骨折可有效降低手术创伤、改善生活质量,建议行临床推广。

Objective To investigate the clinical effect of the treatment of thoracolumbar fracture by internal fixation with screws in the injured vertebrae through the muscular space approach of Wiltse.Methods From Apr.2015 to Jan.2017,the clinical data of 98 patients with thoracolumbar fracture and single segment thoracolumbar fracture with spinal cord injury were analyzed retrospectively,including 57 males and 41 females,aged 21-70 years with an average of 43.6 years.All patients were treated with posterior pedicle screw internal fixation.According to the different operation approach,they were divided into two groups:Wiltse muscular space approach(Wiltse group)and traditional operation approach(traditional group).The bleeding volume and time,postoperative drainage volume,VAS score,ODI score,kyphotic Cobb angle and other indexes and complications were recorded in the two groups before operation,1 day after operation,1 and 12 months after operation and at the last follow-up.Results All the patients successfully completed the operation and were followed up for 13-35 months,with an average of 23.12 months.The bleeding volume and postoperative drainage volume in the Wiltse group were(115.61±12.09)mL and(68.22±11.03)mL,respectively,which were lower than those in the traditional group(179.09±13.81)mL and(123.94±14.15)mL,with statistical significance(P<0.05).The operation time in the Wiltse group was(78.82±7.01)min,longer than that in the traditional group of(77.72±751)min,but the difference was not statistically significant(P>0.05);at the last follow-up,the VAS score(3.10±1.65)and ODI index(8.19±2.09)of patients in the Wiltse group were lower than those in the traditional group of(4.91±1.58)and(11.92±2.93),and the difference was statistically significant(P<0.05);the Cobb angle of patients in the Wiltse group was significantly lower than that in the traditional group(P<0.05).No serious complication occurred in either group.Conclusion The treatment of thoracolumbar fracture by internal fixation with screws in the injured vertebrae through Wiltse muscular space approach can effectively reduce the surgical trauma and improve the quality of life,and it is recommended to be popularized clinically.