经Wiltse肌间隙入路和经皮椎弓根置钉治疗胸腰段脊椎骨折的疗效对比

Comparison of the effect of thoracolumbar spine fracture by trans Wiltse interspace and pedicle screw placement through percutaneous approach

目的对比经Wiltse肌间隙入路与经皮椎弓根置钉治疗胸腰段脊椎骨折的疗效。方法选取46例胸腰段脊椎骨折患者,建立随机数字表随机分为A组、B组,分别予以经Wiltse肌间隙入路椎弓根置钉、经皮椎弓根置钉。对比两组术中透视次数、术中出血量、手术用时、住院时间;对比术后12 h、24 h、48 h、72 h及术后1周的疼痛程度;对比术前、术后即刻、术后6个月的Cobb角、伤椎前缘高度;对比术后6个月脊柱功能。结果A组术中透视次数、手术用时、住院时间均短于B组,差异均有统计学意义(P<0.05),B组术中出血量少于A组(P<0.05);两组术后疼痛程度评分均逐渐下降(P<0.05),A组术后不同疼痛程度评分均低于B组(P<0.05);两组术后即刻、术后6个月Cobb角均小于术前(P<0.05),伤椎前缘高度均高于术前(P<0.05),且术后6个月上述指标均与术后即刻相近(P>0.05),且各时刻两组间指标均相近(P>0.05)。结论经Wiltse肌间隙入路和经皮椎弓根置钉治疗胸腰段脊柱骨折的效果相当,且解剖结构恢复、脊柱功能恢复和安全性均相近,但前者可减少术中透视次数,缩短手术用时和住院时间,且还可减轻术后疼痛程度。

Objective To compare the therapeutic effect of pedicle screw placement in the treatment of thoracolumbar spine fracture through Wiltse muscular space approach and percutaneous approach.Methods A total of 46 cases with thoracolumbar spine fracture were selected and randomly divided into group A and group B,which were treated with pedicle screws placed through the Wiltse muscular space approach and the percutaneous approach respectively.The length of incision,times of intraoperative fluoroscopy,amount of intraoperative bleeding,operation time and hospitalization time were compared between the two groups.The pain degrees were compared at 12 h,24 h,48 h,72 h and 1 week after operation.The Cobb angle and height of anterior edge of injured vertebrae were compared before operation,immediately after operation and 6 months after operation.The spinal function was compared 6 months after operation.Results The times of intraoperative fluoroscopy and intraoperative bleeding in group A were less than those in group B,and the time of operation and hospitalization was shorter than that in group B(P<0.05).The intraoperative blood loss was greater in group A than in group B(P<0.05).The score of pain degree decreased gradually in both two groups(P<0.05),and the scores of postoperative pain in group A were lower than those in group B(P<0.05).Immediately after operation and 6 months after operation,the Cobb angle in two groups was lower than before operation(P<0.05),and the height of the anterior edge of the injured vertebrae were all higher than before operation(P<0.05).There were no significant differences in spinal function distribution,excellent rate and complication rate between the two groups at 6 months after operation(P>0.05).Conclusions The results of pedicle screw placement for thoracolumbar spine fracture through the Wiltse muscular space and through the skin approach are similar,and anatomical structure recovery,spinal function recovery and safety are similar,but the former can reduce the times of intraoperative fluoroscopy,shorten the operation time and hospital stay time,and also can reduce the degree of postoperative pain.