手法复位联合Wiltse椎旁入路内固定治疗胸腰椎骨折的临床效果观察

Clinical Effect of Manual Repositioning Combined with Wiltse's Paravertebral Approach for Internal Fixation of Thoracolumbar Fractures

目的:评价经Wiltse椎旁入路手法整复椎弓根内固定治疗胸腰椎骨折的效果,为临床作参考。方法:选取2017年5月—2019年5月广州市番禺区第二人民医院收治的48例无神经症状的胸腰椎骨折患者为研究对象。根据手术方式不同,将48例患者随机分为实验组(n=24)和对照组(n=24)。实验组采用手法整复加Wiltse椎旁入路椎弓根螺钉内固定,对照组采用后路传统入路椎弓根螺钉内固定术。比较两组患者手术时间(OT)、出血量(BL)、术后引流量(PD)、支撑时间(TB)及受伤后凸畸形俯卧位Cobb角恢复情况、Cobb角变化、血清肌酸激酶(CK)水平、疼痛视觉模拟评分(VAS)、OSwestry功能障碍指数(ODI)、多裂肌横断面积(CSA)变化。结果:实验组BL明显少于对照组,差异有统计学意义(t=29.70,P<0.05)。实验组OT、PD、TB明显优于对照组,差异有统计学意义(t=2.60、24.49、9.60,P<0.05)。术后1 d和3 d,实验组CK均值明显低于对照组,差异有统计学意义(t=1.638、2.753,P<0.05)。术后1个月及末次随访时,实验组患者ODI明显优于对照组,差异有统计学意义(t=2.637、3.125,P<0.05)。在术后Cobb角变化方面实验组优于对照组,差异有统计学意义(t=2.656、3.169,P<0.05)。结论:该手术适用于无神经症状的胸腰椎骨折,术前手法整复具有恢复损伤椎体高度的优点。Wiltse肌间入路可减少术中出血,缩短手术时间,减少椎旁肌损伤。

Objective:To evaluate the effect of internal fixation of thoracolumbar fractures via Wiltse's paravertebral approach with arch root manipulation for clinical reference.Methods:48 patients with thoracolumbar fractures without neurological symptoms admitted to the hospital from May 2017 to May 2019 were selected for the study and randomly divided into experimental group(n=24) and control group(n=24) according to the different surgical methods.In the experimental group,the pedicle screws were fixed using a paravertebral approach with Wiltse,and in the control group,the pedicle screws were fixed using a posterior conventional approach.The operative time(OT),intraoperative bleeding(BL),postoperative drainage(PD),support time(TB) and recovery of Cobb angle in the prone position of the injured posterior convex deformity,Cobb angle changes,serum creatine kinase(CK)levels,pain visual analog score(VAS),OSwestry dysfunction index(ODI),and changes in multifidus transverse area(CSA) were compared between the two groups.Results:BL in the experimental group was significantly less than that in the control group,and the difference was statistically significant(t=29.70,P<0.05).OT,PD,and TB were significantly better in the experimental group than in the control group,with statistically significant differences(t=2.60,24.49,9.60,P<0.05).At 1 d and 3 d postoperatively,the mean CK values in the experimental group were significantly lower than those in the control group,with statistically significant differences(t=1.638,2.753,P<0.05).At 1 month postoperatively and at the final follow-up,the ODI of the experimental group was significantly better than that of the control group,with statistically significant differences(t=2.637,3.125,P<0.05).The postoperative Cobb angle change in the experimental group was better than that in the control group,and the difference was statistically significant(t=2.656,3.169,P<0.05).Conclusion:The procedure is indicated for thoracolumbar fractures without neurological symptoms.Preoperative manipulation has the advantage of restoring the height of the injured vertebral body,and the Wiltse interosseous approach reduces intraoperative bleeding,shortens operative time,and reduces paravertebral muscle injury.