改良Wiltse入路经伤椎椎弓根植骨内固定术治疗胸腰椎爆裂性骨折

Modified Wiltse approach trans-injured vertebra pedicle bone grafting and internal fixation for thoracolumbar burst fractures

目的探讨改良Wiltse入路经伤椎椎弓根植骨内固定术治疗胸腰椎爆裂性骨折的临床疗效。方法回顾性分析2015年1月—2018年12月收治的126例胸腰椎爆裂性骨折患者临床资料。其中64例采取改良Wiltse入路经伤椎椎弓根植骨内固定术治疗(观察组),62例采取常规后路内固定术治疗(对照组)。记录2组手术时间、术中出血量并进行比较。于术前、术后1个月及末次随访时统计椎体高度丢失率、脊柱矢状面Cobb角,以及疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI),评价疗效及预后。结果所有患者随访10~36(18.0±8.6)个月,手术时间、术后1个月椎体高度丢失率、术后1个月脊柱矢状面Cobb角组间比较差异均无统计学意义(P>0.05);观察组术中出血量、术后1个月VAS评分均低于对照组,差异有统计学意义(P<0.05)。末次随访时,观察组椎体高度丢失率、脊柱矢状面Cobb角、VAS评分和ODI均低于对照组,差异有统计学意义(P<0.05)。结论改良Wiltse入路经伤椎椎弓根植骨内固定术治疗胸腰椎爆裂性骨折临床疗效满意,具有手术创伤小、出血量少的优点,并能有效重建骨折椎体高度。

Objective To explore the clinical efficacy of modified Wiltse approach trans-injured vertebral pedicle bone grafting and internal fixation for thoracolumbar burst fractures.Methods A total of 126 patients with thoracolumbar burst fractures from January 2015 to December 2018 were enrolled in the retrospective study.Sixty-four cases were treated by modified Wiltse approach trans-injured vertebral pedicle bone grafting and internal fixation(observation group),and 62 cases were treated by conventional posterior approach internal fixation(control group).The operation time and intraoperative blood loss were recorded and compared between the 2 groups.The loss rate of vertebral body height,Cobb’s angle in the sagittal plane,visual analogue scale(VAS)score and Oswestry disability index(ODI)at pre-operation,postoperative 1 month and the final follow-up were collected to evaluate the efficacy and prognosis.Results All the patients were followed up for 10-36(18.0±8.6)months.There was no significant difference in operation time,loss rate of vertebral body height and Cobb’s angle in the sagittal plane at postoperative 1 month between the 2 groups(P>0.05).The intraoperative blood loss and VAS score in the observation group at postoperative 1 month were significantly lower than those in the control group(P<0.05).At the final follow-up,the loss rate of vertebral body height,Cobb’s angle in the sagittal plane,VAS score and ODI of the observation group were significantly lower than those of the control group(P<0.05).Conclusion The modified Wiltse approach trans-injured vertebral pedicle bone grafting and internal fixation for thoracolumbar burst fractures has satisfactory efficacy,with the advantages of less trauma and blood loss,which can effectively reconstruct the vertebral height.