3种手术方式治疗无神经症状胸腰椎骨折的疗效比较

Comparison of the clinical effects of three different surgical approaches in the treatment of thoracolumbar fractures without neurological symptoms

目的比较传统后正中入路、微创经皮入路和Wiltse入路手术治疗单节段无神经症状胸腰椎骨折的临床疗效。方法将本科于2013年9月~2018年3月收治的单节段无神经症状120例胸腰椎骨折患者分为:传统后正中入路组42例,微创经皮入路组37例,Wiltse入路组41例。比较3种手术方式的手术时间、术中出血量、住院时间、VAS评分、ODI指数及脊柱后凸畸形矫正情况。结果患者随访12~24个月、平均16个月,术后切口均一期愈合,未见神经损伤并发症,随访未见内固定松动及移位。传统后正中入路和Wiltse入路组的手术时间明显短于微创经皮入路,差异有统计学意义(P<0.05);微创经皮入路和Wiltse入路手术出血量、住院时间、术后3个月VAS评分及ODI指数明显优于传统后正中入路,差异有统计学意义(P<0.05);3种手术方式在脊柱后凸畸形矫正方面差异无统计学意义(P>0.05)。结论微创经皮入路和Wiltse入路的手术创伤小、恢复快,突出了微创理念;其中Wiltse入路手术时间短、辐射暴露少,优势更显著。

Objective To compare the clinical efficacy of traditional posterior median approach,minimally invasive percutaneous approach and Wiltse approach in the treatment of single segment of thoracolumbar fractures without neurological symptoms.Methods From September 2013 to March 2018,120 cases of single segment of thoracolumbar fractures without neurological symptoms were treated in our department.According to the different operation approach,the patients were divided into three groups,including traditional posterior median approach group(42 cases),minimally invasive percutaneous approach group(37 cases)and Wiltse approach group(41 cases).The operation time,intraoperative blood loss,hospitalization time,VAS scale,Oswestry dysfunction index(ODI),and the correction of kyphosis were recorded and compared among the three groups.Results All patients were followed up for 12-24 months,the average follow-up was 16 months.The incisions were all healed by the first intention and recovered without any nerve injury complications.No broken screw,broken rods and internal fixation loosening occurred.Compared with minimally invasive percutaneous approach,traditional posterior median approach and Wiltse approach had shorter operation time,the difference was significant(P<0.05).Compared with traditional posterior median approach,minimally invasive percutaneous approach and Wiltse approach had less blood loss,shorter hospitalization time(P<0.05).The VAS and ODI scores of minimally invasive percutaneous approach and Wiltse approach were significantly lower than those of the traditional posterior median approach at 3 months after operation(P<0.05).There was no significant difference in the correction of kyphosis(P>0.05).Conclusions Minimally invasive percutaneous approach and Wiltse approach have minimally invasion,can achieve less surgical trauma and faster recovery.However,Wiltse approach has the advantages of less operation time and radiation exposure.