摘要
目的探讨经Wiltse入路内固定治疗胸腰椎骨折的临床效果。方法回顾性分析2016年7月—2020年6月成都医学院第一附属医院骨科治疗的83例胸腰椎骨折患者临床资料。其中男性52例,女性31例;年龄24~72岁,平均52.2岁;致伤原因:道路交通伤54例,高处坠落伤22例,摔伤5例,其他2例;按照入路不同分为Wiltse组(n=43)和对照组(n=40)。Wiltse组行经Wiltse入路椎弓根钉内固定,对照组行后路椎弓根钉内固定(PPSF)。观察两组术中失血量、术中透视时间、手术时间、术后下地时间等围术期指标,术前、术后3d、1年疼痛程度,术后半年及1年椎体功能,术前、术后1d、半年及1年后凸Cobb角、伤椎前缘高度比,以及术后并发症。结果Wiltse组术中失血量(79.09±8.22)mL、术中透视时间(2.14±0.22)min、手术时间(52.86±5.43)min、术后下地时间(2.2±0.2)d均少于对照组[(108.39±12.14)mL、(3.82±0.40)min、(68.17±7.15)min、(3.9±0.4)d],P<0.05。术前、术后1年,Wiltse组视觉模拟评分(VAS)[(7.85±0.80)分、(0.86±0.09)分]与对照组[(7.83±0.79)分、(0.91±0.10)分]差异无统计学意义(P>0.05)。术后3d,Wiltse组VAS(2.27±0.25)分低于对照组(4.81±0.51)分(P<0.05)。术后半年及1年,Wiltse组功能障碍指数(ODI)[(15.75±1.89)分、(13.07±1.45)分]与对照组[(16.08±1.92)分、(12.63±1.30)分]差异无统计学意义(P>0.05)。术前及术后1d、半年及1年,Wiltse组后凸Cobb角[(23.76±2.48)°、(4.83±0.53)°、(4.75±0.51)°、(4.74±0.49)°]、伤椎前缘高度比[(47±5)%、(90±9)%、(88±9)%、(86±8)%]与对照组[(23.73±2.45)°、(4.78±0.52)°、(4.73±0.50)°、(4.80±0.52)°,(47±5)%、(90±9)%、(89±9)%、(87±9)%]比较,差异均无统计学意义(P>0.05)。Wiltse组术后并发症发生率(4.65%)低于对照组(22.50%,P<0.05)。结论经Wiltse入路内固定治疗胸腰椎骨折可获得与经后路一致的疗效,并且具有术后短期疼痛轻、并发症发生率低、恢复快等优势。
Objective To study the clinical effect of treatment of thoracolumbar fracture with pedicle screw fixation via Wiltse approach.Methods Clinical data of 83 thoracolumbar fracture patients treated in our hospital from Jul.2016 to Jun.2020 were retrospectively analyzed and divided into Wiltse group(n=43)and control group(n=40)according to surgical approaches.Among them,there were 52 males and 31 females;the age ranged from 24 to 72 years,with an average of 52.2 years;causes of injury:54 cases of road traffic injuries,22 cases of falling from heights,5 cases of fall injuries,and 2 other cases.The Wiltse group received screw fixation via Wiltse approach pedicle,and the control group received posterior pedicle screw fixation(PPSF).Perioperative period index such as intraoperative blood loss,intraoperative fluoroscopy time,operation time,postoperative ground time were observed in the two groups.The pain degree before operation,3 days and 1 year after operation,vertebral body function at 6 months and 1 year after operation,Cobb angle of kyphosis before operation,1 day,6 months and 1 year after operation,anterior edge height ratio of injured vertebra and postoperative complications were observed.Results In the Wiltse group,the intraoperative blood loss was(79.09±8.22)mL,intraoperative fluoroscopy time was(2.14±0.22)minutes,operation time was(52.86±5.43)minutes,and postoperative out-of-bed time was(2.2±0.2)days,which were less than those in the control group[(108.39±12.14)mL,(3.82±0.40)minutes,(68.17±7.15)minutes,(3.9±0.4)days,P<0.05].Before surgery and 1 year after surgery,the visual analogue scale(VAS)of the Wiltse group was(7.85±0.80)points and(0.86±0.09)points,which was(7.83±0.79)points and(0.91±0.10)points in the control group(P>0.05).On the 3rd day after operation,the VAS of the Wiltse group(2.27±0.25)points was lower than that of the control group(4.81±0.51)points(P<0.05).Six months and one year after operation,there was no significant difference in the functional disability index(ODI)between the Wiltse group[(15.75±1.89)points,(13.07±1.45)points]and the control group[(16.08±1.92)points and(12.63±1.30)points(P>0.05)].Before operation and at 1day,6 months and 1 year after operation,the Cobb angle of kyphosis in the Wiltse group was(23.76±2.48)°,(4.83±0.53)°,(4.75±0.51)°,(4.74±0.49)°,respectively,the ratio of anterior edge height of the injured vertebrae was(47±5)%,(90±9)%,(88±9)%,(86±8)%,respectively;in the control group,the Cobb angle of kyphosis was(23.73±2.45)°,(4.78±0.52)°,(4.73±0.50)°,(4.80±0.52)°,respectively,the anterior edge height ratio of injured vertebra was(47±5)%,(90±9)%,(89±9)%,(87±9)%,respectively,and the difference was not statistically significant(P>0.05).The incidence of postoperative complications in the Wiltse group(4.65%)was lower than that in the control group(22.50%,P<0.05).Conclusion Pedicle screw fixation via Wiltse approach for thoracolumbar fracture can achieve the same efficacy as PPSF,and has the advantages of less paravertebral muscle dissection,less trauma,less pain,and faster postoperative recovery.
作者
邓利平
余媛媛
张理
廖羽
常山
Deng Liping;Yu Yuanyuan;Zhang Li;Liao Yu;Chang Shan(Department of Orthopedics,The First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)
出处
《创伤外科杂志》
2022年第3期182-186,共5页
Journal of Traumatic Surgery
关键词
胸腰椎骨折
内固定
入路
thoracolumbar fracture
internal fixation
approach
