肌间隙入路与后正中入路治疗胸腰段单节段爆裂性骨折临床疗效比较

Comparison of efficacy between muscle space approach and posterior median approach in surgical treatment for single-segment thoracolumbar burst fractures

目的回顾性对比分析肌间隙入路(Wiltse入路)与传统后正中入路治疗胸腰段单节段爆裂性骨折的临床效果。方法自2015年1月—2018年1月,采用经伤椎置钉治疗单节段胸腰段爆裂性骨折73例,其中Wiltse入路44例,传统后正中入路29例,损伤分类及损伤程度TLICS评分>4分,术前脊髓神经功能评定全部为Frankel E级。观察手术时间、术中出血量、术后引流量、手术前后肌酸激酶、椎体前缘高度,后凸角(Cobb角),VAS评分的临床疗效。结果73例患者中,65例患者得到随访,内固定术后随访时间1645个月,平均(31±1.5)个月。所有患者螺钉位置良好,未出现脊髓神经损伤现象。(1)两组患者在术前椎体高度、Cobb角、肌酸激酶、VAS评分等资料比较,差异均无统计学意义(P>0.05),具有可比性;(2)两组患者手术时间、术中出血量、术后引流量方面差异有统计学意义(P<0.001);(3)总体治疗效果:两组患者间内固定术后椎体前缘高度改善率及后凸畸形改善率无明显差异(P>0.05),Wiltse组内固定术后肌酸激酶含量水平明显低于传统组(P<0.05);Wiltse组内固定术后腰背痛VAS评分优于传统组(P<0.05);Wiltse组末次随访时,多裂肌形态良好,传统组多裂肌形态消失,被无规则疤痕组织取代。结论Wiltse入路治疗单节段胸腰段爆裂性骨折较传统手术入路具有手术时间短、创伤出血少、明显缓解腰背部疼痛、术后康复快等优点,临床疗效满意。

Objective To compare the clinical efficacy of muscle space approach(Wiltse approach)and traditional posterior median approach in the treatment of thoracolumbar single-segment burst fractures.Methods Seventy-three patients with thoracolumbar burst fractures were treated by pedicle screw placement through the injured vertebra from January 2015 to January 2018,including 44 cases treated through the Wiltse approach and 29 cases through the traditional posterior median approach.The injury classification and injury degree TLICS score>4 points,and the preoperative spinal cord nerve function was FrankelE.The operation time,intraoperative blood loss,postoperative drainage volume,preoperative and postoperative creatine kinase,anterior vertebral height,kyphosis angle(Cobb angle),VAS score were compared between two groups.Results Of the 73 patients,65 patients were followed up for 16 to 45 months,with an average of(31±1.5)months.All the screws were in good position and no spinal cord injury occurred.There was no significant difference in vertebral height,Cobb angle,creatine kinase,and VAS score between the two groups before operation(P>0.05).The operation time was shorter,the intraoperative blood loss and postoperative drainage volume were significantly less in Wiltse group than those in the traditional group(P<0.001).There was no significant difference in the improvement rate of anterior vertebral height and kyphosis between the two groups after internal fixation(P>0.05).The creatine kinase level after internal fixation in the Wiltse group was significantly lower than that in the traditional group(P<0.05).The VAS score of low back pain after internal fixation in the Wiltse group was better than that in the traditional group(P<0.05).At the last follow-up,the morphology of the multifidus muscle in the Wiltse group was normal,while the morphology of the multifidus muscle in the traditional group disappeared and was replaced by irregular scar tissue.Conclusion In the treatment of single-level thoracolumbar burst fractures,Wiltse approach has the advantages of shorter operation time,less trauma and bleeding,significant back pain relief,and faster postoperative recovery compared to traditional approach.