不同手术方式在治疗胸腰椎骨折中的临床研究

Comprehensive comparison of three surgical methods in treatment of thoracolumbar fracture

目的比较传统后路手术、Wiltse入路和经皮椎弓根螺钉内固定治疗无神经损害症状的单节段胸腰椎骨折的疗效、副损伤等围手术期指标。方法回顾性分析2014年1月至2017年8月采用三种不同方法治疗胸腰椎单节段骨折患者92例,按手术方式分为传统手术入路内固定(A组30例),Wiltse入路内固定(B组34例),经皮内固定(C组28例)。比较3组皮肤切口长度、手术时间、术中出血量、术中X线曝光次数,检测血清肌酸激酶(CK)水平,测量伤椎前缘高度、矢状面Cobb角度、末次随访时ODI值及住院费用。结果所有患者随访12~24个月,平均(13.5±2.3)个月,3组患者手术切口长度及椎体前缘高度、矢状面Cobb角度恢复情况差异无统计学意义(P>0.05)。A组术中出血量高于B组和C组;C组手术时间长于A、B组;C组X线曝光次数多于A、B组;A组术后24 h、48 h血清肌酸激酶(CK)水平均明显高于B、C组;末次随访时A组ODI值高于B、C组,C组住院费用多于A组和B组,差异均有统计学意义(P<0.05)。结论在治疗单节段胸腰椎骨折中,3组患者均取得良好的复位及维持效果,但考虑到出血量、手术时间、肌肉损伤情况、X线曝光次数及卫生经济等指标时,经Wiltse入路存在一定优势,目前更适合临床推广应用。

Objective To investigate the therapeutic effects and perioperative indexes of traditional posterior approach,Wiltse approach and percutaneous pedicle screw fixation in treatment of single-level thoracolumbar fractures without neurological impairment symptoms.Methods The clinical data about 92 patients with single-level thoracolumbar fractures without neurological impairment symptoms were treated by three surgical methods respectively in our hospital from January 2014 to August 2017 were retrospectively analyzed,According different surgical methods,these patients were divided into three groups:traditional routine surgical approach(group A,n=30),Wiltse approach(group B,n=34),percutaneous fixation(group C,n=28).The skin incision length,operative time,intraoperative blood loss,intraoperative X-ray exposure times,the serum levels of creatine kinase(CK),the anterior vertebral height ratio,the sagittal Cobb Angle and ODI value were observed and compared among the three groups.Results All the patients were followed up for 12~24 months,with average follow up time being(13.5±2.3)months.There were no significant differences in surgical incision length,the anterior vertebral height ratio and the recovery rate of sagittal Cobb Angle among the three groups(P>0.05).The intraoperative blood loss in group A was significantly higher than that in group B and C.The operative time of group C was significantly longer than that in group A and B.The X ray exposure time in group C was significantly higher than that in group A and B,and the serum levels of creatine kinase(CK)at 24 hours and 48 hours after surgery in group A were significantly higher than those in group B and C.At the last follow-up,the ODI value in group A was significantly higher than that in group B and C,and the economic cost of hospitalization in group C was significantly higher than that in group A and B(P<0.05).Conclusion In the treatment of single segmental thoracolumbar vertebra fracture,the three kinds of methods can achieve good reduction and maintenance effects,however,considering the blood loss,operation time,muscle injury,X-ray exposure times and health economy,the Wiltse approach has certain advantages,which is more suitable for clinical application at present.