摘要
目的探讨经Wiltse肌间隙入路伤椎椎弓根置钉治疗胸腰段脊柱骨折的效果。方法将33例无神经症状的胸腰段脊柱骨折患者根据手术入路及内固定方式的不同分为3组:经Wiltse肌间隙入路伤椎置钉组(A组,11例);经Wiltse肌间隙入路伤椎不置钉组(B组,11例);经后正中入路伤椎不置钉组(C组,11例)。比较3组的手术时间、术中出血量、术后Cobb角矫正率、术后椎体坍塌矫正率及术后疼痛VAS评分。结果33例患者均获得随访,时间12～16. 5个月。骨折均骨性愈合,愈合时间5～9个月。均未出现钉棒系统松动、断裂。手术时间、术中出血量及末次随访时VAS评分A、B组均优于C组(P <0. 05)。末次随访时,患者Cobb角及椎体坍塌矫正率A组优于B、C组(P <0. 05)。结论经Wiltse肌间隙入路治疗胸腰段脊柱骨折具有手术操作简单、术中出血量减少、手术时间缩短、术后腰疼症状较轻等优势;结合伤椎置钉能有效维持椎体复位,加强伤椎的稳定性,减小后凸畸形。
Objective To investigate the clinical efficacy of injured vertebral screw fixation for thoracolumbar fractures with Wiltse paraspinal approach.Methods The 33 thoracolumbar fracture patients without spinal decompression were divided into 3 groups:thoracolumbar fractures with injured vertebral screw fixation with Wiltse paraspinal approach(Group A,11 cases);thoracolumbar fractures without injured vertebral screw fixation with Wiltse paraspinal approach(Group B,11 cases);posterior midline approach without injured vertebral screw fixation(Group C,11 cases).The 3 groups were evaluated by the operative time,intraoperative blood loss,postoperative Cobb angle correction rate,postoperative vertebral collapse correction rate and postoperative pain VAS.Results All 33 patients were followed up for 12~16.5 months.All patients got bony union,bony union time was 5~9 months.No broken screws,broken rods and internal fixation loosening occurred.Operative time,intraoperative blood loss and VAS at the last follow-up in group A and B were better than those in group C(P<0.05).At the last follow-up,the Cobb angle and vertebral collapse correction rate in group A were better than those in group B and C(P<0.05).Conclusions Internal fixation with Wiltse paraspinal approach has the advantages of simple approach,less intraoperative injuries,less operative time and limited complications.Injured vertebral screw fixation for thoracolumbar fractures with Wiltse paraspinal approach helps to restore the fractures,stabilize the segments and reduce kyphosis deformity.
作者
章有才
杨祖华
ZHANG You-cai;YANG Zu-hua(SectionⅠ,Dept of Orthopaedics,the Third People′s Hospital of Hefei,Hefei,Anhui 230022,China)
出处
《临床骨科杂志》
2018年第6期659-662,共4页
Journal of Clinical Orthopaedics
关键词
Wiltse肌间隙入路
胸腰椎骨折
经伤椎固定
Wiltse paraspinal approach
thoracolumbar fractures
injured vertebral fixation
