Wiltse肌间隙入路与传统后入路椎弓根钉内固定治疗胸腰椎骨折的比较  

Clinical efficacy of Wiltse muscle approach and posterior midline approach in treatment of thoracolumbar fractures

作　　者：张映波[1] 张超[1] 谢海洋[1] 李奎[1] 付能高[1] 何江涛[1] 蔚芃[1] 蒋成[1] 

机构地区：[1]川北医学院附属医院骨科,四川南充637000

出　　处：《中国骨与关节损伤杂志》2016年第11期1124-1127,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的比较分析腰椎后路Wiltse肌间隙入路与腰椎传统后正中入路椎弓根钉内固定治疗胸腰椎骨折的疗效。方法回顾性分析自2011-01—2016—01诊治的109例胸腰椎骨折。分别采用Wiltse肌间隙入路与腰椎传统后正中入路行切开复位椎弓根钉内固定治疗，其中Wiltse入路组47例，后正中入路组62例。比较2组手术时间、术中出血量、术后引流量、术后卧床时间，术后12h、3d、7d的血清肌酸激酶，术后1周、6个月的VAS评分，以及术后6个月的JOA评分。结果109例均获得随访6～14个月，平均9．6个月。2组手术时间比较差异无统计学意义（P〉0．05）。Wihse入路组术中出血量、术后引流量、术后卧床时间均少于后正中入路组，差异有统计学意义（P〈0．05）。Wiltse入路组术后12h、术后3d血清肌酸激酶低于后正中入路组，差异有统计学意义（P〈0．05）；2组术后7d比较差异无统计学意义（P〉0．05）。Wiltse入路组术后1周、6个月的VAS评分低于后正中入路组，术后6个月JOA评分高于后正中入路组，差异有统计学意义（P〈0．05）。结论与腰椎传统后正中入路相比，Wiltse肌间隙入路出血量较少，对椎旁肌及小关节囊的损伤小，术后慢性腰痛发生率低，符合脊柱微创手术理念。Objective To evaluate the clinical efficacy of the Wiltse muscle approach and posterior midline approach in the treatment of thoracolumbar fractures with pedicle screw fixation. Methods One hundred and nine cases of thoracic and lumbar spine fractures treated ：from Jan, 2011 to Jan. 2016 were retrospectively analyzed. Wihse muscle approach and posterior midline approach were used respectively for open reduction and internal fixation with pedicle screw fixation, with 47 cases in Wihse muscle approach group and 62 cases in posterior median approach group. The operation time, blood loss, postoperative drainage, postoperative lying in bed time, serum creatine kinase 12 hours, 3 days, 7 days after operation, the VAS score 1 week and 6 months after operation, and the JOA score 6 months after operation were compared between two groups. Results All 109 cases were followed up for 6-14 months, average 9.6 months. There was no significant difference in operation time between the 2 groups （P 〉0.05）. The amount of blood loss, postoperative drainage and bed time after operation in the Wihse group were less than that in the posterior median approach group, and the difference was statistically significant （P 〈0.05）. The serum creatine kinase 12 hours and 3 days after operation in the Wihse muscle approach was lower than those in the posterior median approach group, the difference was statistically significant （P 〈0.05）. The VAS score 1 week and 6 months after operation in Wihse group was lower than that in posterior median approach group, and the JOA score 6 months after operation in Wihse group washigher than that in posterior median approach group, and the difference was statistically significant （P 〈0.05）. Conclusion Compared with the traditional posterior midline approach, the Wihse muscle approach has less bleeding, less small joint capsule injury,, lower incidence of chronic low back pain, which is consistent with the concept of minimally invasive spinal surgery.

关 键 词：胸腰椎骨折 Wiltse肌间隙入路 后正中入路 椎弓根钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]