椎旁肌间隙入路单侧椎板有限开窗椎管减压复位固定治疗胸腰椎爆裂骨折  

Unilateral laminae limited fenestration and spinal canal decompression reduction and fixation for treatment of thoracolumbar burst fracture with paraspinal muscle space approach

作　　者：曾俊[1] 林旭[1] 王翔宇 胡海刚[1] 谭伦[1] 魏琴[1] ZENG Jun;LIN Xu;WANG Xiang-yu;HU Hai-gang;TAN Lun;WEI Qin(SectionⅠ,Dept of Orthopaedics,the Fourth People′s Hospital of Zigong City,Zigong,Sichuan 643000,China)

机构地区：[1]自贡市第四人民医院骨1科,四川自贡643000

出　　处：《临床骨科杂志》2022年第3期323-327,共5页Journal of Clinical Orthopaedics

基　　金：四川省卫健委科学研究项目(编号:19PJ309)。

摘　　要：目的探讨椎旁肌间隙入路(Wiltse入路)单侧椎板有限开窗椎管减压复位固定治疗胸腰椎爆裂骨折的疗效。方法将60例胸腰椎爆裂骨折患者根据手术方式不同分为3组,每组20例:(1)A组——采用后路全椎板切除椎管减压复位固定术;(2)B组——采用单侧椎弓根内侧壁切除椎管减压复位固定术;(3)C组——采用Wiltse入路单侧椎板有限开窗椎管减压后路复位固定术。比较3组手术情况及影像学指标。结果患者均获得随访,时间7~24个月。(1)手术时间、术中出血量、术后引流量:C组明显短(少)于A、B组,差异均有统计学意义(P<0.05);A组与B组比较差异均无统计学意义(P>0.05)。(2)伤椎前缘高度百分比、伤椎后凸Cobb角、椎管矢状径压缩百分比:3组术后1周、末次随访时均明显优于术前(P<0.05),末次随访与术后1周比较差异均无统计学意义(P>0.05);术后各时间点3组比较差异均无统计学意义(P>0.05)。结论Wiltse入路单侧椎板有限开窗椎管减压复位固定治疗胸腰椎爆裂骨折手术时间较短、出血量较少、并发症少,可最大限度保留后方稳定结构,临床疗效满意。Objective To investigate the clinical effect of thoracolumbar burst fracture with unilateral laminae limited fenestration and spinal canal decompression reduction and fixation via paraspinal muscle space approach(Wiltse approach).Methods The 60 patients with thoracolumbar burst fractures were divided into three groups according to different surgical methods,with 20 patients in each group:(1)Group A:treated with decompression,reduction and fixation of spinal canal with posterior total laminectomy;(2)Group B:unilateral pedicle medial wall resection was used for decompression,reduction and fixation of spinal canal;(3)Group C:the Wiltse approach was used for unilateral laminae decompression with limited fenestration and posterior reduction and fixation.The operative conditions and imaging indexes of the three groups were compared.Results All patients were followed up for 7~24 months.(1)Operation time,intraoperative blood loss and postoperative drainage volume:group C was significantly shorter(less)than group A and B,the differences were statistically significant(P<0.05);there was no statistical difference between group A and B(P>0.05).(2)The percentage of the anterior edge height of the injured vertebrae,the kyphotic Cobb angle of the injured vertebrae and the percentage of sagittal diameter compression of spinal canal:at 1 week and the last followup postoperation,three groups were significantly better than those before operation(P<0.05),and there were no significant differences between the last follow-up and 1 week postoperation(P>0.05).There were no significant differences in postoperative various time-points among three groups(P>0.05).Conclusions The Wiltse approach for the treatment of thoracolumbar burst fractures with unilateral laminae limited fenestration,decompression,reduction and fixation has shorter operation time,less blood loss,few complications,and which can furthest maintain the posterior stable structure,with satisfactory clinical efficacy.

关 键 词：胸腰椎爆裂骨折 有限开窗 椎管减压 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]