Wiltse入路结合单侧伤椎置钉治疗胸腰椎骨折的疗效分析  

Treatment of Thoracolumbar Fractures with Wiltse Approach Combined with Unilateral Vertebral Nail Placement

作　　者：葛行新 张姚 魏东 李华 王云清 房明亮 曹贞国 刘加元 GE Xing-xin;ZHANG Yao;WEI Dong(The second affiliated hospital of Xuzhou medical university,general hospital of Xuzhou mining group,Xuzhou,Jiangsu 221006)

机构地区：[1]徐州医科大学第二附属医院—徐州矿务集团总医院,江苏徐州221006

出　　处：《中国伤残医学》2021年第23期1-4,共4页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:观察Wiltse入路结合单侧伤椎椎弓根置钉治疗胸腰椎骨折的临床疗效.方法:回顾性观察2017年6月-2019年6月采用手术治疗的37例单节段胸腰椎骨折患者,其中19例采用Wiltse入路结合单侧伤椎椎弓根置钉的5钉固定治疗(观察组),18例采用常规后正中入路跨伤椎4钉固定治疗(对照组),比较,2组的手术时间、围术期失血量,术后2组患者的肌酸激酶水平以及术后6个月伤椎前缘高度比、脊柱后凸Cobb角、疼痛VAS评分.结果:所有患者均获得随访,时间6-12个月.手术时间、围术期失血量、术后肌酸激酶水平、住院时间,观察组均少于对照组,差异均有统计学意义(P<0.05).术后1周伤椎前缘高度比、脊柱后凸Cobb角2组比较,差异均无统计学意义(P>0.05).术后6个月伤椎前缘高度比、脊柱后凸Cobb角2组比较,差异具有统计学意义(P<0.05).术后VAS评分观察组低于对照组,差异有统计学意义(P<0.05).结论:相比较传统手术,Wiltse入路具有创伤小,手术时间短、围术期失血少,结合伤椎单侧置钉可以有效的增强内固定的牢靠性,维持矫正角度,因此Wiltse入路结合伤椎单侧置钉可作为治疗不需要椎管减压的椎体骨折的首选方法.Objective:To observe the clinical effect of Wiltse approach combined with pedicle screw placement in the treatment of thoracolumbar fracture.Methods:From June 2017 to June 2019,37 patients with single segment thoracolumbar fractures were treated by operation.Among them,19 patients were treated by Wiltse approach combined with pedicle screw fixation of unilateral injured vertebra(group A),18 patients were treated by conventional posterior median approach combined with 4-screw fixation of injured vertebra(group B).The operation time and perioperative blood loss of the two groups were compared,and the creatine kinase level of the two groups was as follows And 6 months after the operation,the anterior height ratio of the injured vertebrae,the Cobb angle of kyphosis,and the VAS score of pain.Results:All patients were followed up for 6-12 months.The operation time,perioperative blood loss,postoperative creatine kinase level and hospital stay in group A were less than those in group B,the difference was statistically significant(P<0.05).There was no significant difference between the two groups(P>0.05).There were significant differences in the height ratio of anterior edge and Cobb angle of kyphosis between the two groups(P<0.05).The VAS score of group A was lower than that of group B(P<0.05).Conclusion:Compared with the traditional operation hand,the Wiltse approach has the advantages of less trauma,shorter operation time and less blood loss during the peri operation.It can effectively enhance the stability of internal fixation and maintain the correction angle by combining the unilateral fixation of the injured vertebra.Therefore,the Wiltse approach combined with the unilateral fixation of the injured vertebra can be used as the first choice for the treatment of vertebral fractures without spinal canal decompression.

关 键 词：胸腰椎骨折 Wiltse入路 单侧固定 万向椎弓根螺钉 单向椎弓根螺钉 

分 类 号：R683.1[医药卫生—骨科学]