椎弓根螺钉内固定不同入路方式治疗无神经症状单节段胸腰椎骨折疗效对比

Comparison of Clinical Efficacy of Pedicle Screw Fixation by Different Approaches in the Treatment of Single⁃segment Thoracolumbar Fractures Without Neurologic Symptoms

目的对比分析经椎旁肌间隙椎弓根螺钉内固定(Wiltse入路)与Sextant经皮椎弓根螺钉内固定(Sextant经皮入路)治疗无神经症状单节段胸腰椎骨折的临床效果。方法选取2015年3月至2021年10月安阳市殷都区中医院收治的72例无神经症状单节段胸腰椎骨折患者作为研究对象,按照不同手术方法将其分为Wiltse组(39例)和Sextant组(33例),Wiltse组患者采用经椎旁肌间隙椎弓根螺钉内固定治疗,Sextant组患者采用Sextant经皮椎弓根螺钉内固定治疗,对比观察两组患者手术相关指标、疼痛程度以及骨折椎体前缘高度比值、Cobb角与椎体功能。结果Wiltse组患者术中出血量明显多于Sextant组(t=11865,P<0001),术中透视次数明显少于Sextant组(t=19892,P<0001),手术时间明显短于Sextant组(t=3442,P<0001),住院时间明显长于Sextant组(t=8962,P<0001);术后6个月,Wiltse组患者视觉模拟评分法(VAS)评分及Oswestry功能障碍指数(ODI)评分均明显低于Sextant组(t=6878、13070,P均<0001),而骨折椎体前缘高度比值及Cobb角与Sextant组无明显差异(t=1658、1628,P=0102、0108)。结论经椎旁肌间隙椎弓根螺钉内固定与Sextant经皮椎弓根螺钉内固定对无神经症状单节段胸腰椎骨折的矫正效果相当,但经椎旁肌间隙椎弓根螺钉内固定的手术时间更短,术后远期疼痛程度更轻,椎体功能恢复效果更好,临床应用价值更高。

Objective To compare the clinical efficacy of pedicle screw fixation by paraspinal approach(Wiltse approach)and pedicle screw fixation by Sextant percutaneous approach(Sextant percutaneous approach)in the treatment of single-segment thoracolumbar fractures without neurologic symptoms.Methods 72 patients with single-segment thoracolum-bar fractures without neurologic symptoms,admitted to Anyang Yindu District Hospital of Traditional Chinese Medicine from March 2015 to October 2021,were enrolled as the research subjects,and divided into Wiltse group(n=39)receiving pedicle screw fixation by paraspinal approach,and Sextant group(n=33)receiving pedicle screw fixation by Sextant percutaneous approach.Surgery-related indicators,pain degree,and anterior vertebral body height ratio,Cobb angle and vertebral function were observed and compared between the two groups.Results Compared with the Sextant group,the intraoperative blood loss volume was much more(t=11865,P<0001),the intraoperative fluoroscopy times were much less(t=19892,P<0001),the operation time was significantly shorter(t=3442,P<0001),and the length of stay was obviously longer(t=8962,P<0001)in the Wiltse group.6 months after surgery,patients in the Wiltse group had significantly lower visual analogue scale(VAS)scores and Oswestry disability index(ODI)scores compared with the Sextant group(t=6878 and 13070,both P<0001),but there were no significant differences between the two groups in terms of anterior vertebral body height ratio and Cobb angle(t=1658 and 1628,P=0102 and 0108).Conclusion Wiltse approach and Sextant percutaneous approach can realize equivalent effect in correcting single-segment thoracolumbar fractures without neurologic symptoms.However,the Wiltse approach is superior in many aspects,including less intraopera-tive blood loss,shorter operation time,milder long-term pain after the surgery,and better recovery effect of vertebral functions,presenting much higher value of clinical application.