经Wiltse肌间隙入路与经皮椎弓根螺钉内固定治疗胸腰椎A3型骨折患者的临床效果

Comparison of Pedicle Screw Internal Fixation Via Wiltse Muscular Space Approach and Percutaneous Pedicle Screw Internal Fixation in the Treatment of Thoracolumbar A3 Type Fractures

目的比较经Wiltse肌间隙入路与经皮椎弓根螺钉内固定治疗胸腰椎A3型骨折患者的疗效差异。方法回顾性分析2015年1月至2019年8月医院收治的82例胸腰椎A3型骨折患者,42例行经皮椎弓根螺钉内固定术作为对照组,40例行Wiltse入路肌间隙入路作为试验组,比较两组手术时间、术中出血量、住院时间和X线透视时间,以及术后视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)评分。结果对照组手术时间、X线透视时间均长于试验组,差异有统计学意义(P<0.05);两组术中出血量和住院时间比较,差异无统计学意义(P>0.05);术后3个月,两组VAS、ODI评分均较术前改善,但组间差异无统计学意义(P>0.05)。结论经皮椎弓根螺钉内固定和Wiltse肌间隙入路治疗胸腰椎A3型骨折患者均可获得良好的临床疗效,但经Wiltse肌间隙入路手术时间、术中X线透视时间更短,可以优先选择。

Objective To compare the clinical effect of the treatment of A3 fracture of thoracolumbar spine by Wiltse approach and percutaneous pedicle screw fixation.Methods 82 patients with A3 fracture of thoracolumbar spine from January 2015 to August 2019 were analyzed retrospectively.42 patients underwent percutaneous pedicle screw fixation as the control group and 40 patients underwent Wiltse approach as the test group.The operation time,intraoperative blood loss,hospitalization time,X-ray fluoroscopy time,VAS and ODI score were compared between the two groups.Results The total time of operation and X-ray fluoroscopy in the group of percutaneous internal fixation was longer than that in the group of Wiltse approach(P<0.05).There was no significant difference in intraoperative blood loss and hospital stay between the two groups(P>0.05).The VAS and ODI score of the two groups were significantly improved after 3 months,but there was no significant difference between the two groups(P>0.05).Conclusion Percutaneous pedicle screw technique and Wiltse approach can achieve good clinical effect in the treatment of thoracolumbar A3 fracture.But Wiltse approach has shorter operation time,shorter X-ray fluoroscopy time and shorter learning curve,which can be selected preferentially.