Quadrant通道下经Wiltse入路治疗胸腰段单椎体爆裂性骨折临床疗效分析  

Retrospective Study of the Clinical Effect of Quadrant Channels through Wiltse Approach in Treatment of Single-level Thoracolumbar Bursting Fractures

作　　者：李四波[1] 陈晓春[1] 姜海涛[1] 顾小华[1] Li Sibo;Chen Xiaochun;Jiang Haitao(Department of Orthopaedics,7th People’s Hospital of Shanghai,Shanghai 200137,China)

机构地区：[1]上海市第七人民医院骨科,上海200137

出　　处：《实用骨科杂志》2018年第12期1057-1060,共4页Journal of Practical Orthopaedics

基　　金：上海市卫生计生委资助项目(201640389)

摘　　要：目的回顾性分析Quadrant通道下经肌间隙(Wiltse)入路伤椎置钉治疗胸腰段单椎体爆裂性骨折的临床效果。方法自2014年1月至2017年1月,采用Quadrant通道下经Wiltse入路伤椎置钉(六钉两棒)治疗单节段胸腰段爆裂性骨折48例,术前按AO分型,A3.1型29例,A3.2型19例;脊髓神经功能全部为Frankel E级。术后10个月常规取出内固定。通过观察手术前后椎体前缘高度、后凸角、VAS及JOA评分变化评估其临床疗效。结果 48例患者全部得到随访,随访时间12～42个月,平均25.5个月。术后即刻椎体前缘高度较术前恢复良好(P<0.05),后凸畸形较术前改善明显(P<0.05),VAS疼痛评分由术前6.5分改善至2.3分,JOA评分由术前13.38分提高至16.85分,螺钉位置及稳定性良好,未出现脊髓、神经根损伤现象。结论 Quadrant通道下经Wiltse入路伤椎置钉治疗单节段胸腰椎爆裂性骨折具有操作简单、手术创伤小、进钉点定位准确、术后康复快等优点,临床疗效满意。Objective To retrospectively analyze clinical effect of pedicle screw internal fixation through the injured vertebra for treating single-level thoracolumbar bursting fracture in the quadrant expansive channel combined with the muscular gap(wiltse)approach.Methods From January 2014 to January 2017,48 cases of single-level thoracolumbar bursting fracture were treated with 2 rods and 6 screws in 6 vetebra including the injured vetebra through the quadrant expansive channel with Wiltse approach.According to AO classification,there were 29 cases of type A 3.1 and 19 cases of type A 3.2.Spinal nerve function were all Frankel E.10 months after operation,the internal fixation were explanted.Clinical effect was evaluated by observing the vertebral anterior height,kyphosis,VAS and JOA score changes before and after operation.Results All cases were followed up for 12 to 42 months with an average of 25.5 months.The anterior height of vertebral body recovered well(P<0.05)immediately after operation.And kyphosis was improved significantly(P<0.05).The VAS score was improved from 6.5 points to 2.3 points,and the JOA score increased from 13.38 points to 16.85 points.Screw position and stability was good.No injury of spinal cord function was found.Conclusion The quadrant expansive channel combined with Wiltse approach by the injured vertebral set screw in the treatment of single thoracolumbar bursting fracture has the advantages of simple operation,less trauma,accurate screw entrance point,fast recovery after operation,and has satifying effect.

关 键 词：QUADRANT通道 肌间隙入路 胸腰椎骨折 椎弓根螺钉 

分 类 号：R683.2[医药卫生—骨科学]