Wiltse肌间隙入路与常规入路治疗胸腰椎骨折的临床比较  

A retrospective trial of Wiltse’s muscle gap approach versus conventional approach on the treatment of thoracolumbar vertebral fractures

作　　者：姚晓聪[1] 崔永锋[1] 朱宝华[1] 管功奎[1] 

机构地区：[1]浙江省杭州市萧山区第一人民医院,浙江杭州311200

出　　处：《中医正骨》2013年第11期16-18,共3页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:探讨经Wiltse肌间隙入路治疗胸腰椎骨折的可行性。方法:回顾性分析48例胸腰椎骨折患者的病历资料,经常规手术入路行后路椎弓根螺钉内固定术者25例为对照组(A组);经Wiltse肌间隙入路行椎弓根螺钉内固定者23例为观察组(B组)。比较2组患者的手术时间、切口长度、术中出血量、引流量、术后疼痛视觉摸拟评分、Cobb’s角及术后日本骨科协会评分。结果:A组患者的手术时间、出血量、引流量术后VAS评分均大于B组[(80.04±9.650)min,(60.48±6.374)min,t=8.210,P=0.000;(280.40±56.60)mL,(180.43±60.11)mL,t=5.934,P=0.000;(161.60±44.31)mL,(120.00±28.28)mL,t=3.838,P=0.000;(5.792±1.444),(3.087±1.203),t=3.838,P=0.000];2组患者的切口长度、术后JOA评分及手术前后Cobb’s角比较,差异均无统计学意义[(10.40±1.49)cm,(10.33±1.49)cm,t=0.171,P=0.865;(27.280±1.487),(26.348±1.921),t=1.889,P=0.065;(22.060±4.887),(22.870±5.513),t=-0.539,P=0.592;(6.204±1.737),(6.844±1.359),t=-1.412,P=0.165]。结论:与常规手术入路相比,经Wiltse肌间隙入路内固定治疗胸腰椎骨折具有手术时间短、出血量少及术后疼痛程度低的优点,值得推广。Objective： To explore the feasibility of Wiltse＇ s muscle gap approach on the treatment of thoracolumbar vertebral fractures. Methods：The medical records of 48 patients with thoracolumbar vertebral fractures were retrospectively analyzed. Twenty-five patients （group A）were administrated with posterior pedicle screw internal fixation by conventional operative approach, while the others （group B ） were administrated with posterior pedicle screw internal fixation by Wiltse＇ s muscle gap approach. The two groups were compared with each other in such parameters as operative time, length of incision, blood loss, drainage volume, postoperative VAS score, Cobb＇ s angle and post- operative JOA score. Results： The operative time, blood loss, drainage volume, postoperative VAS score were larger of group A were all high- er than those of groupB（ 80.04 ＋/- 9. 650 vs 60.48 ＋/- 6. 374 rain ,t = 8. 210 ,P = 0. 000 ;280.40 ＋/- 56.60 vs 180.43 ＋/- 60.11 mL,t = 5. 934, P = 0. 000;161.60 ＋/-44.31 vs 120.00 ＋/-28.28 mL,t = 3. 838, P = 0. 000;5. 792 ＋/- 1. 444 vs 3. 087 ＋/- 1. 203, t = 3. 838, P = 0.000）. There was no statistical difference in the length of incision, postoperative JOA score and Cobb＇ s angle preoperative and postop- erative between the 2 groups （ 10.40 ＋/- 1.49 vs 10.33 ＋/- 1.49 cm, t = 0. 171, P = 0. 865 ;27. 280 ＋/- 1. 487 vs 26. 348 ＋/- 1.921, t = 1. 889, P = 0. 065 ;22. 060 ＋/- 4. 887 vs 22. 870 ＋/- 5.513, t = - 0. 539, P = 0. 592 ;6. 204 ＋/- 1. 737 vs 6. 844 ＋/- 1. 359, t = - 1. 412, P = O. 165 ）. Conclusion： Compared with conventional operation approach, the Wiltse＇ s muscle gap approach on the treatment of thoracolum- bar vertebral fracture has such advantages as shorter operation time, less blood loss and lower degree of postoperative pain, so it is worth popularizing in clinic.

关 键 词：脊柱骨折 胸椎 腰椎 骨折固定术 内 Wiltse肌间隙入路 治疗 临床研究性 

分 类 号：R687.3[医药卫生—骨科学]