Wiltse入路治疗胸腰椎骨折的疗效分析  

Curative effect analysis of thoracolumbar fractures treatment through Wiltse approach

作　　者：许耀[1] 陈文钧[1] 马晓生[1] 王立勋[1] 姜建元[1] 

机构地区：[1]复旦大学附属华山医院骨科,上海200040

出　　处：《脊柱外科杂志》2011年第2期95-97,共3页Journal of Spinal Surgery

摘　　要：目的探讨经Wiltse入路复位内固定治疗胸腰椎骨折的临床疗效。方法 2008年1月～2010年1月,本院手术治疗胸腰椎骨折患者32例,男17例,女15例;年龄为18～63岁,平均年龄43岁。手术治疗病例均为Denis分型为压缩型骨折、爆裂型骨折和屈曲过伸骨折且不需后路减压的患者。其中T12椎体骨折10例,L1椎体骨折18例,L2椎体骨折4例。随机分为常规入路和Wiltse入路2组,分析手术时间、出血量、复位前后Cobb角度改变、术后疼痛视觉模拟量表(visual analogue scale,VAS)评分以及6个月随访腰背痛日本骨科协会(Japanese Orthopaedic Association,JOA)评分。结果经Wiltse入路组在术中出血量和术后负压引流量上均明显低于常规入路组,术后48小时内疼痛VAS评分明显低于常规入路组,Cobb角术后恢复情况2组没有明显差异。术后6月随访腰背痛JOA评分常规入路组略高于Wiltse入路组,但差异无统计学意义(P>0.05)。结论 Wiltse入路经肌间隙分离进入,可直接定位上关节突,便于椎弓根螺钉置入,恢复椎体高度效果好,减少椎旁肌剥离引起的肌肉疼痛,减少术中损伤,加快术后恢复。Objective To evaluate the clinical outcomes of thoracolumbar fractures treatment through Wiltse approach.Methods From January 2008 to January 2010,32 patients who suffered from thoracolumbar fractures without neurological symptoms underwent surgical treatment,including 17 males and 15 females,with an average age of 43 years（ranged 18-63 years）.All the cases were suffered from compression fracture,blowout fracture and flexure-hyperextension fracture according to the Denis classification,which did not need posterior decompression.T12 vertebral body fracture in 10 cases,L1 vertebral body fracture in 18 cases and L2 vertebral body fracture in 4 cases.They were divided into 2 equal groups randomly,one group were treated with the traditional approach,the other group were treated with the Wiltse approach.Blood loss,volume of drainage,operation time,Cobb＇s angle,visual analogue scale（VAS） score and Japanese Orthopaedic Association（JOA） score of back pain postoperative were analyzed.Results Wiltse approach had obvious advantages in blood loss,volume of drainage,operation time,and 48 h postoperative VAS score.The Cobb＇s angle restoration was almost the same,the difference was not statistically significant（P0.05）.Conclusion The Wiltse approach can directly located to the superior articular process through spatium intermusculare,easy for pedicle screw insertion.Compared with traditional approach,it has more advantages such as better result of recovering vertebrae height,less myalgia resulting from paraspinal muscle dissection,less intraoperative injuries,and shorter recovery time.

关 键 词：胸椎 腰椎 脊柱骨折 治疗结果 

分 类 号：R683.2[医药卫生—骨科学]