经皮与Wiltse入路椎弓根钉治疗单节段胸腰椎骨折的临床疗效观察

Clinical effect of percutaneous and Wiltse approach in single segment thoracolumbar fracture

目的观察分析经皮椎弓根螺钉内固定术与Wiltse入路椎弓根钉内固定术治疗单节段胸腰椎骨折的临床疗效。方法回顾性分析自2019年6月至2021年1月于重庆三峡医药高等专科学校附属中医院就诊的符合单节段胸腰椎骨折诊断的76例患者,其中31例采取经皮入路椎弓根螺钉复位固定治疗(PPS组),45例采取Wiltse入路椎弓根螺钉复位固定治疗(WPS组)。对两组的术中用时、术中出血量、术中透视次数,术后3 d、3个月、6个月的VAS评分和ODI功能评分,以及术后1 d、3个月、1年的Cobb角及椎体前缘恢复率进行比较分析。结果对76例患者进行为期1年的随访,病例无脱落,经对各时间节点比较分析显示:术中用时及术中透视次数的组间比较,WPS组明显优于PPS组,差异有统计学意义(P<0.05);两组术中出血量比较,差异无统计学意义(P>0.05);两组患者术后3 d的VAS及ODI评分比较,PPS组明显优于WPS组,差异有统计学意义(P<0.05);术后3、6个月的VAS评分及ODI评分组间比较,差异无统计学意义(P>0.05);两组患者术后1 d、3个月、1年的Cobb角及椎体前缘恢复率比较,WPS组明显优于PPS组,差异有统计学意义(P<0.05)。结论Wiltse入路与经皮椎弓根螺钉内固定术治疗单节段胸腰椎骨折皆具有良好、确切的临床效果,其中WPS组术中透视次数更少,且术后Cobb角、椎体前缘压缩程度恢复更好。

Objective To observe and analyze the clinical efficacy of percutaneous pedicle screw fixation and Wiltse approach pedicle screw fixation in the treatment of single segment thoracolumbar fractures.Methods The 76 patients with single segment thoracolumbar fractures who were admitted to the Affiliated Hospital of Traditional Chinese Medicine of Chongqing Three Gorges Medical College from June 2019 to January 2021 were retrospectively analyzed.Thirty-one cases were treated with percutaneous pedicle screw reduction and fixation(PPS group),and 45 cases were treated with Wiltse approach(WPS group).The operative time,intraoperative blood loss,intraoperative fluoroscopy times,VAS score and ODI function score at 3 d,3 months and 6 months after surgery,as well as the Cobb angle and the vertebral anterior margin recovery rate at 1 d,3 months and 1 year after surgery were compared and analyzed.Results Seventy-six patients were followed up for 1 year,and none of them shed.The comparison of operative time and intraoperative fluoroscopy times showed that the WPS group was significantly better than PPS group,with statistical significance(P<0.05).After the comparative analysis of each time node showed that there was no significant difference in intraoperative blood loss between the two groups(P>0.05).The comparison of VAS and ODI scores at 3 days after surgery between the two groups showed that PPS group was significantly better than WPS group,and the difference was statistically significant(P<0.05).The comparison of VAS score and ODI score 3 months and 6 months after surgery showed no statistical significance(P>0.05).The Cobb angle and vertebral anterior margin recovery rate of the two groups at 1 d,3 months and 1 year after surgery were compared,WPS group was significantly better than PPS group,and the difference was statistically significant(P<0.05).Conclusion Both the Wiltse approach and percutaneous pedicle screw fixation in the treatment of single segment thoracolumbar fractures have good and accurate clinical results,in which the WPS group has less intraoperative fluoroscopy and better recovery of Cobb angle and anterior vertebral margin compression after surgery.