经皮椎弓根置钉与经Wiltse肌间隙入路治疗胸腰段脊椎骨折的疗效

A comparative study of percutaneous pedicle screw placement and Wiltse intermuscular approach for the treatment of thoracolumbar spinal fractures

目的比较经皮椎弓根置钉与经Wiltse肌间隙入路治疗胸腰段脊椎骨折的近期效果。方法选取2021年4月—2023年3月收治的60例胸腰段脊椎骨折患者作为研究对象,根据其治疗方式不同分为观察组与对照组,各30例,观察组患者采用经Wiltse肌间隙入路手术方式进行治疗,对照组患者采用经皮椎弓根置钉手术方式进行治疗,对比两组患者术中出血量、透视次数、手术时长与住院时间;对比两组患者术后12、24、48、72 h及术后1周的疼痛程度;对比两组患者术前、术后即刻、术后6个月的Cobb角、伤椎前缘高度;对比两组患者术后6个月的并发症情况。结果两组患者临床指标中术中出血量观察组多于对照组;术中透视次数观察组少于对照组;手术时长观察组短于对照组;住院时间观察组短于对照组;术后各阶段疼痛评分等级观察组患者均优于对照组(P<0.05);术后各阶段Cobb角与伤椎前缘高度数据相近,差异无统计学意义(P>0.05);两组患者术后6个月均无发生固定松动或伤口感染等并发症(P>0.05)。结论在胸腰段脊椎骨折患者手术中,使用经皮椎弓根置钉与经Wiltse肌间隙入路两种手术方式均可以对患者的机体功能恢复起到良好的效果,但行经Wiltse肌间隙入路手术方式可以缩短患者手术术程时间,减少透视次数与缩短住院时间,同时减少患者术后疼痛程度,手术出血量可控。

Objective To compare the short-term effects of percutaneous pedicle screw placement and Wiltse intermuscular approach on thoracolumbar spinal fractures.Methods Sixty patients with thoracolumbar spinal fractures admitted from April 2021 to March 2023 were selected and divided into a control group and an observation group,with 30 patients in each group.The observation group patients were treated with percutaneous pedicle screw placement surgery,while the control group patients were treated with the Wiltse intermuscular approach surgery.The intraoperative bleeding volume,fluoroscopy frequency,surgical duration,and hospital stay of the two groups of patients were compared;the pain levels between the two groups at 12,24,48,72 and 1 week after surgery were compared;the Cobb angle and anterior edge height of the injured vertebra between the two groups before,immediately after,and 6 months after surgery were compared;the spinal functions of two groups of patients at 6 months after surgery were compared.Results Among the clinical indicators,the observation group had more intraoperative bleeding than the control group;the intraoperative fluoroscopy frequency in the observation group was less than that in the control group;the surgical duration in the observation group was less than that in the control group;the hospitalization time in the observation group was shorter than that in the control group;the postoperative pain scores of patients in the observation group were better than those in the control group at all stages(P<0.05);There was no statistically significant difference(P>0.05)in the Cobb angle and the height of the anterior edge of the injured vertebral body in each postoperative stage.There were no complications such as fixation loosening or wound infection of both groups of patients 6 months after surgery(P>0.05).Conclusion In the operation of thoracolumbar spinal fracture,the use of percutaneous pedicle screws and Wiltse intermuscular approach play a good role in the recovery of patients.Wiltse intermuscular approach can shorten the operation time,reduce the number of fluoroscopy,hospital stay,and postoperative pain of patients,and control the amount of surgical bleeding.