经皮与Wiltse入路短节段椎弓根钉内固定联合伤椎置钉治疗胸腰段脊柱骨折的比较  

Percutaneous pedicle screw and Wiltse approach pedicle screw combined with fixation at injured vertebrae in treatment of thoracolumbar spine fractures

作　　者：刘宁[1] 杨波[1] 贺西京[2] 王盛海[1] 李维[1] 陈建华[1] 杨艳[1] 雷海春 杨华[1] 

机构地区：[1]汉中市中心医院脊柱外科一病区,陕西723000 [2]西安交通大学第二附属医院骨二科

出　　处：《中国骨与关节损伤杂志》2018年第1期9-12,共4页Chinese Journal of Bone and Joint Injury

基　　金：陕西省卫生厅科研基金项目(2012E8)

摘　　要：目的比较经皮与Wiltse入路短节段椎弓根钉内固定联合伤椎置钉植骨治疗无神经损伤胸腰段脊柱骨折的疗效。方法回顾性分析自2013-06—2015-01采用后路短节段椎弓根钉内固定联合伤椎置钉植骨治疗的48例无神经损伤单节段胸腰段脊柱骨折,经皮组24例,Wiltse组24例。比较2组切口长度、手术时间、术中出血量、住院时间,术后3 d、末次随访时伤椎椎体前缘高度比值、Cobb角、VAS评分、ODI指数。结果 48例随访时间均超过24个月,平均26.5个月。与Wiltse组比较,经皮组切口长度更短,术中出血量更少,手术时间及住院时间更短,差异有统计学意义(P<0.05)。经皮组术后3 d、末次随访时伤椎椎体前缘高度比值、Cobb角与Wiltse组比较差异无统计学意义(P>0.05)。经皮组术后3 d的VAS评分、ODI指数与Wiltse组比较差异无统计学意义(P>0.05);但末次随访时经皮组VAS评分、ODI指数低于Wiltse组,差异有统计学意义(P<0.05)。结论经皮与Wiltse入路短节段椎弓根钉内固定联合伤椎置钉植骨治疗无神经损伤胸腰段脊柱骨折疗效肯定,但经皮椎弓根钉内固定手术创伤更小,术后远期疼痛缓解更明显且功能恢复更满意。Objective To compare the outcome of percutaneous short-segment pedicle screw and Wiltse approach pedicle screw combined with fixation at the injured vertebrae in the treatment of traumatic thoracolumbar spine fractures without neurologic deficits. Methods From Jun. 2013 to Jan. 2015, 48 patients with single segmental burst fractures of the thoracolumbar junction but without neurologic deficits were reviewed retrospectively, 24 cases in percutaneous group and 24 cases in Wiltse group. The length of incision, the operation time, the intraoperative blood loss, hospital stay, and the anterior vertebral body height, the Cobb angle, the VAS score and ODI index at 3 d after operation and at the final follow-up were compared. Results All 48 cases were followed up for over 24 months, with an average of 26.5 months. Compared with the Wihse group, the incision length in the percutaneous group was shorter, the intraoperative blood loss was less, the operation time and hospital stay were shorter, and the differences were statistically significant （P 〈0.05）. There were no significant differences in the ratio of anterior vertebral height and the angle of Cobb between at 3 d after operation and the final follow- up group between the percutaneous group and the Wiltse group （P 〉0.05）. There were no significant differences between the percutaneous group and Wiltse group in VAS score, ODI index at 3 d after operation （P 〉0.05）; but the percutaneous group at the final follow-up had lower VAS score and ODI index than those of Wiltse group, the differences were statistically significant （P 〈0.05）. Conclusion Percutaneous short-segment pedicle screw and Wihse approach pedicle screw combined with fixation and bone graft at the injured vertebrae in the treatment of traumatic thoracolumbar spine fractures without neurologic deficits have affirmative clinical curative effect, but the percutaneous pedicle screw fixation has the advantages of less surgical trauma, more obvious postoperative long-term pain relief and mo

关 键 词：胸腰段脊柱骨折 微创 Wiltse入路 椎弓根钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]