经Wiltse 肌间隙入路置入椎弓根螺钉固定治疗多节段非连续性胸腰椎骨折的疗效观察

The effect of pedicle screw fixation via Wiltse approach in the treatment of multilevel noncontiguous thoracolumbar fractures

目的观察经Wiltse肌间隙入路置入椎弓根螺钉治疗多节段非连续性胸腰椎骨折的临床疗效。方法回顾性分析陆军军医大学大坪医院脊柱外科2016年9月-2019年5月收治的24例多节段非连续性胸腰椎骨折的病例资料,男性17例,女性7例;年龄29~63岁,平均44.7岁。致伤原因:高处坠落伤17例,道路交通伤7例。术中采用后路经Wiltse入路置入椎弓根螺钉固定多节段非连续性胸腰椎骨折,统计患者的手术时间、术中出血量、术后引流量、VAS评分、ODI评分情况以及术前、术后、末次随访时关键骨折椎体Cobb角等临床资料。结果患者均顺利完成手术。手术时间90~150min,平均120.8min;失血量100~240mL,平均150.6mL;术后第1天引流量为70~120mL,平均为100.5mL;术前VAS评分平均为7.6分,术后为2.3分,疼痛明显缓解;术前ODI指数平均为26.7分,术后为8.2分;术前关键骨折椎体Cobb角平均为27.8°,术后1周为9.1°,末次随访时为9.9°。术后随访3~32个月,患者症状均明显缓解,术后无医源性脊髓损伤发生,脊柱活动度正常。结论经Wiltse肌间隙入路置入椎弓根螺钉固定治疗多节段非连续性胸腰椎骨折能有效减少手术创伤,加速患者恢复,临床疗效明确。

Objective To observe the efficacy of pedicle screw fixation via Wiltse approach in the treatment of multilevel noncontiguous thoracolumbar fractures.Methods Totally 24 cases diagnosed with multi-level thoracolumbar fractures from Sep. 2016 to May 2019 were retrospectively analyzed,including 17 males and 7 females aged 29-63(average,44.7) years. Injury causes include 17 cases of high falling and 7 cases of traffic accidents.They were treated by posterior pedicle screw fixation via Wiltse approach. Clinical data such as operation time,intraoperative bleeding,postoperative drainage,VAS score,ODI score,and Cobb angle of key fracture vertebral body pre-operatively,post-operatively,and at the last follow-up were collected.Results All patients successfully completed the surgery.The operation time ranged from 90 to 150 minutes.The average time was 120.8 minutes.The blood loss ranged from 100 to 240 mL,with an average of 150.6 mL.The drainage volume at the first day after surgery was 70-120 mL,with an average of 100.5 mL.The average VAS score was 7.6 before surgery and 2.3 after surgery,and the pain was relieved obviously.The average ODI score was 26.7 before surgery and 8.2 after surgery.The average Cobb angle of key fracture vertebral body was 27.8°before surgery, 9.1° at 1 week after surgery, and 9.9°at the last follow-up.All patients were followed up for 3 to 32 months.The symptoms of all patients were relieved obviously,no iatrogenic spinal cord injury occurred after surgery,and the motion of spine was normal.Conclusion The treatment of multi-level thoracolumbar fractures with pedicle screw fixation via Wiltse approach can effectively reduce surgical trauma and accelerate patient rehabilitation. It has good clinical effect.