经皮与Wiltse入路椎弓根钉治疗TLICS 4分胸腰段骨折的疗效对比  

Comparison of Percutaneous Versus Wiltse Approach with Pedicle Screws in the Treatment of Thoracolumbar Fractures with TLICS 4

作　　者：翁友林 李祖涛 蔡昱 孙俊刚[1] 徐江波[1] Weng Youlin;Li Zutao;Cai Yu(Department of Orthopaedic Trauma,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China)

机构地区：[1]新疆维吾尔自治区人民医院骨科创伤病区,新疆乌鲁木齐830000

出　　处：《实用骨科杂志》2021年第12期1057-1063,共7页Journal of Practical Orthopaedics

摘　　要：目的探讨经皮与Wiltse入路伤椎椎弓根螺钉内固定在治疗单节段、无神经损伤、胸腰椎损伤分类及损伤程度(thoracolumbar injury assification and severity,TLICS)评分4分的胸腰段骨折的疗效。方法回顾性研究我院2016年1月至2019年1月收治的胸腰段骨折患者,其中64例符合研究标准纳入研究。采用成组匹配分组,分为经皮伤椎椎弓根螺钉置钉组(经皮组)和Wiltse入路伤椎椎弓根螺钉置钉组(Wiltse入路组),其中经皮组32例,男19例,女13例;年龄21~55岁,平均(36.42±6.31)岁;术前后凸Cobb角18°~35°,平均(24.72±4.64)°。Wiltse入路组32例,其中男21例,女11例;年龄19~52岁,平均(38.52±6.62)岁。术前后凸Cobb角20°~36°,平均(25.72±5.14)°。所有纳入研究病例均采用经伤椎6枚椎弓根螺钉置钉固定。比较两组手术时间、术中失血量、切口大小、住院天数、术中透视次数,术前1 d及术后1 d、3 d、7 d、14 d疼痛视觉模拟评分(visual analogue scale,VAS),术后及术后1年后凸Cobb角,术后1年随访Oswestry功能障碍指数(oswestry disability index,ODI)评分。结果所有患者均获得12~18个月随访,平均随访(15.62±3.76)个月。两组病例随访期间均未发生医源性血管神经损伤、切口感染、内固定失效等并发症;两组手术时间、术中失血量、切口大小、住院天数、术前后凸Cobb角比较,差异无统计学意义(P>0.05);术前1 d及术后1 d、3 d、7 d、14 d VAS评分比较,差异无统计学意义(P>0.05);术中透视次数经皮组明显多于Wiltse入路组,差异有统计学意义(P<0.05);两组术后Cobb角均较术前明显减小,且组间、组内比较差异均有统计学意义(P<0.05);两组术后1年随访ODI评分比较,差异无统计学意义(P>0.05)。结论经皮与Wiltse入路伤椎椎弓根螺钉固定在治疗单节段、无神经损伤、TLICS 4分的胸腰段骨折方面近期疗效相当,但Wiltse入路组术中透视次数更少,且术后Cobb角恢复更好,是否存在�Objective To compare the efficacy of percutaneous and Wiltse approach pedicle screw fixation with injured vertebrae in the treatment of single segmental,non-nerve injury and thoracolumbar injury assification and severity(TLICS)-4 thoracolumbar fractures.Methods A retrospective study was conducted on the patients with thoracolumbar fracture treated in our hospital from January 2016 to January 2019,of which 64 cases met the study criteria.The patients were divided into two groups using category matching:percutaneous pedicle screw group(percutaneous group)and Wiltse pedicle screw group(Wiltse group).There were 32 cases in percutaneous group,including 19 males and 13 females,aged from^(2)1 to 55 years old,with an average of(36.42±6.31)years.The kyphosis Cobb angle before and after operation was 18°~35°,with an average of(24.72±4.64)°.There were 32 patients in the Wiltse approach group,including 21 males and 11 females,aged from 19 to 52 years old,with an average age of(38.52±6.62)years.The preoperative and postoperative kyphosis Cobb angle ranged from^(2)0°~36°,with an average of(25.72±5.14)°.All the patients in the study were fixed with 6 pedicle screws through the injured vertebrae.The operation time,intraoperative blood loss,incision size,hospitalization days,intraoperative fluoroscopy times,Visual analogue scale(VAS)of 1 day before operation,1 day,3 days,7 days and 14 days after operation,postoperative and postoperative kyphosis Cobb angle were recorded and compared between the two groups.Oswestry disability index(ODI)score was followed up 1 year after operation.All patients were followed up for 12~18 months,with an average of(15.62±3.76)months.Results During the follow-up period,no complications such as iatrogenic vascular and nerve injury,incision infection and failure of internal fixation occurred in both groups.There was no significant difference in operation time,intraoperative blood loss,incision size,hospital stay and Cobb angle before and after operation between the two groups(P>0.05).There was

关 键 词：胸腰段骨折 Wiltse入路 TLICS评分 

分 类 号：R683.2[医药卫生—骨科学]