Wiltse入路联合选择性关节突融合治疗胸腰椎骨折的临床疗效分析

Effects of Wiltse approach combined with selective facet joint fusion for treatment of thoracolumbar fracture

目的观察经Wiltse入路联合选择性关节突融合治疗胸腰椎骨折的临床效果及手术节段运动功能的恢复情况。方法回顾性分析我院2011年3月至2018年3月收治的98例胸腰椎压缩性骨折手术患者的临床资料,根据手术不同入路分为Wiltse入路组和后正中入路组,各49例。比较2组患者手术时间、出血量、卧床时间、引流量、手术前后伤椎后凸Cobb角、VAS评分、JOA评分、取出内固定后椎间活动度等指标。结果98例患者获得6~42个月随访,平均15.8个月。Wiltse入路组术中出血量、术后引流量、术后卧床时间均少于后正中入路组,差异具有统计学意义(P<0.05)。2组患者术后VAS、JOA评分较术前明显改善,差异具有统计学意义(P<0.05);除术后2 d Wiltse入路组VAS评分低于后正中入路组外(P<0.05),2组间术后VAS评分、JOA评分差异无统计学意义(P>0.05)。术后1周和术后3个月,2组患者伤椎椎体Cobb角均明显低于术前,差异有统计学意义(P<0.05)。2组患者术后6个月、12个月取出内固定患者未融合节段活动度明显高于术后18个月取出患者,差异有统计学意义(P<0.05)。结论处理胸腰椎骨折时,选择性融合终板损伤节段并适时取出内固定能够保留非融合节段的运动功能,而Wiltse入路较传统后正中入路具有微创优势。

Objective To analyze the effect of Wiltse approach combined with selective facet joint fusion for treatment of thoracolumbar fracture and motor function recovery of the operative segment.Methods The clinical data of 98 patients with thoracolumbar compression fracture who were admitted into our hospital from March 2011 to March 2018 were retrospectively analyzed.According to different surgical approaches,they were divided into Wiltse approach group and posterior median approach group,with 49 cases in each group.The operation time,blood loss,time in bed,drainage volume,Cobb Angle,VAS score,JOA score and intervertebral mobility after internal fixation removal were compared between the two groups.Results The 98 patients were followed up for 6 to 42 months,averagely 15.8 months.The intraoperative blood loss,postoperative drainage volume and time in bed postoperatively in the Wiltse approach group were all lower than those in the posterior median approach group,with statistically significant differences(P<0.05).The VAS and JOA scores of the two groups were significantly improved compared with those of the two groups before surgery,and the differences were statistically significant(P<0.05).There was no significant difference in VAS score and JOA score between the two groups(P>0.05),except at the time of 2 days after operation when the VAS score of Wiltse approach group was lower than that of posterior median approach group(P<0.05).One week after the operation and 3 months after the operation,Cobb Angle of the injured vertebra in both groups were significantly lower than that before the operation,and the differences were statistically significant(P<0.05).The intervertebral mobility of the non-fusion segment in the patients who removed the internal fixation at 6 and 12 months after surgery was higher than that who removed the internal fixation at 18 months after surgery,the difference was significant(P<0.05).Conclusion In the treatment of thoracolumbar fractures,selective fusion of the injured segment of the endplate and timely removal of internal fixation can preserve the motor function of the non-fusion segment,and Wiltse approach has a minimally invasive advantage over the traditional posterior median approach.