Wiltse入路及Kambin三角微创减压术治疗上腰椎爆裂骨折合并神经损伤临床疗效研究  

Clinical efficacy of Wiltse approach and Kambin’s triangle approach minimally invasive decompression in the treatment of upper lumbar burst fracture complicated with nerve injury

作　　者：周凤金 郭群峰 陈金水 ZHOU Fengjin;GUO Qunfeng;CHEN Jinshui(Department of Orthopaedics and Traumatology,Honghui Hospital,Xi’an 710054,China;不详)

机构地区：[1]西安市红会医院创伤骨科,陕西西安710054 [2]海军军医大学附属长征医院骨科,上海200003 [3]联勤保障部队第900医院骨一科,福建福州350025

出　　处：《陕西医学杂志》2022年第2期199-203,共5页Shaanxi Medical Journal

基　　金：福建省科技计划项目(2020Y0077)。

摘　　要：目的:探讨经Wiltse入路及Kambin三角微创减压术治疗上腰椎爆裂骨折合并神经损伤的临床疗效。方法:124例因创伤导致的上腰椎爆裂骨折合并神经损伤并接受后路手术治疗的患者,其中60例采用经Wiltse入路及Kambin三角入路进行减压固定,归为新型减压组,64例接受传统开放式后路手术的患者,归为传统减压组。收集两组患者的手术信息,包括手术时间、失血量、引流量、住院天数,并进行比较。术前、术后和术后12个月对患者采用美国脊髓损伤协会(ASIA)损伤量表和视觉模拟疼痛评分(VAS)进行评估。结果:新型减压组患者的手术时间更短[(108.3±21.0)min与(131.0±28.1)min,P<0.001],失血量更少[(212.3±105.3)ml与(401.5±193.2)ml,P<0.01]和引流量更少[(61.7±42.1)ml与(251.4±82.6)ml,P<0.01],住院时间更短[(6.2±1.4)d与(8.1±2.1)d,P<0.001]。两组均根据ASIA等级获得了相似的神经恢复[恢复指数(0.91±0.51)与(0.84±0.52),P>0.05]。术后新型减压组疼痛水平显着降低[(2.4±0.6)与(3.4±0.8),P<0.001]和随访12个月[(1.5±0.8)与(2.3±0.7),P<0.001]。结论:对于上腰椎骨折伴神经损伤的治疗,与传统的后路手术相比,该新方法创伤小、手术时间短、出血少、操作相对简单、术后恢复快,神经功能恢复疗效相当。Objective:To investigate the clinical efficacy of Wiltse approach and Kambin’s triangle approach minimally invasive decompression in the treatment of upper lumbar burst fracture complicated with nerve injury.Methods:124 patients with upper lumbar burst fracture complicated with nerve injury caused by trauma were treated with posterior surgery,of which 60 patients were treated with decompression and fixation through Wiltse approach and Kambin’s triangle approach and divided into the new decompression group,and 64 patients who underwent traditional open posterior surgery were divided into the traditional decompression group.The operation information of the two groups,including operation time,blood loss,drainage volume and hospital stay,were collected and compared.The patients were evaluated with the American Spinal Cord Injury Association(ASIA)injury scale and Visual Analog Scale(VAS)before,after and 12 months after operation.Results:Patients in the new decompression group had fewer operation time[(108.3±21.0)min vs.(131±28.1)min,P<0.01],less blood loss[(212.3±105.3)ml vs.(401.5±193.2)ml,P<0.001]and drainage volume[(61.7±42.1)ml vs.(251.4±82.6)ml,P<0.001],as well as shorter hospitalization stay than the traditional decompression group[(6.2±1.4)day vs.(8.1±2.1)day,P<0.001].According to ASIA grade,similar neurologic recovery was achieved in both groups[recovery index:(0.91±0.51)vs.(0.84±0.52),P>0.05].While the pain level was significantly lower in the new decompression group postoperatively[(2.4±0.6)vs.(3.4±0.8),P<0.001]and at 12-month follow-up[(1.5±0.8)vs.(2.3±0.7),P<0.001].Conclusion:For the treatment of upper lumbar fracture with nerve injury,compared with the traditional posterior surgery,this new method has the advantages of less trauma,shorter operation time,less bleeding,relatively simple operation and rapid postoperative recovery,and the curative effect of nerve function recovery is equivalent.

关 键 词：胸腰椎爆裂性骨折 上腰椎 神经损伤 手术入路 Wiltse入路 Kambin三角 

分 类 号：R683.2[医药卫生—骨科学]