经皮微创、Wiltse间隙微创入路与传统切开后入路治疗老年胸腰椎骨折临床疗效  

Clinical efficacy of percutaneous minimally invasive,Wiltse minimally invasive approach and traditional posterior approach for the treatment of thoracolumbar fracture in senile patients

作　　者：李佳[1] 朱家星 王磊[1] 车晓明[1] 张欣[1] 单中书[1] 刘伟[1] LI Jia;ZHU Jia-xing;WANG Lei;CHE Xiao-ming;ZHANG Xin;SHAN Zhong-shu;LIU Wei(Department of Orthopedics,Qinghai Provincial People′s Hospital,Xining 810007,Qinghai,China)

机构地区：[1]青海省人民医院骨科,青海西宁810007

出　　处：《广东医学》2023年第12期1523-1529,共7页Guangdong Medical Journal

基　　金：青海省卫健委指导性计划课题(2019-wjzdx-10)。

摘　　要：目的探讨经皮微创、Wiltse间隙微创及传统切开后入路联合伤椎椎弓根内固定术治疗老年胸腰椎骨折的临床效果。方法回顾性分析2018年3月至2021年12月诊断为胸腰椎骨折的老年患者98例的临床资料。根据手术入路的不同,将患者分为经皮组、Wiltse组和切开组,经皮组31例,其中男14例,女17例。平均年龄(69.3±6.6)岁;Wiltse组33例,男12例,女21例;平均年龄(68.7±7.1)岁;切开组34例,其中男16例,女18例,平均年龄(67.7±6.9)岁。比较3组患者的手术时间、术中出血量、术后引流量、透视次数、住院时间、Cobb′s角、伤椎椎体前缘高度、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及相关并发症。结果3组术后伤椎前缘高度和Cobb′s角较术前均有明显改善(P<0.05),术后3组组间比较差异无统计学意义(P>0.05)。3组患者围手术期各项观察指标对比,经皮组的手术时间和透视次数比其他两组明显较多,差异有统计学意义(P<0.05);切开组术中出血量、住院时间与其他两组比较差异有统计学意义(P<0.05);3组间的术后引流量相互比较差异均有统计学意义(P<0.05)。3组患者术后VAS评分及ODI值较术前均降低(P<0.05),且经皮组及Wiltse组患者术后的VAS评分和ODI值均优于切开组患者(P<0.05)。切开组术后出现手术及基础疾病相关并发症较多,与其他两组比较差异有统计学意义(P<0.05)。结论治疗老年胸腰椎骨折,3种方法均可取得较好的临床效果,但经皮及Wiltse间隙微创入路相较于传统切开在软组织保护和术后功能康复方面更具优势,临床应用还需根据患者具体情况,采用合适的治疗方式才能够取得更好的疗效。Objective To evaluate the clinical efficacy of percutaneous,Wiltse′s approach minimally invasive,and traditional open approaches combined with pedicle fixation of injured vertebrae for treating thoracolumbar fractures in old patients.Methods A retrospective analysis was conducted on 98 elderly patients diagnosed with thoracolumbar vertebral fractures from March 2018 to December 2021.Patients were categorized into three groups based on the surgical approach:percutaneous group[31 cases,14 males,17 females,average age(69.3±6.6)years],Wiltse group[33 cases,12 males,21 females,average age(68.7±7.1)years],and open group[34 cases,16 males,18 females,average age(67.7±6.9)years].Surgical time,intraoperative blood loss,postoperative drainage volume,fluoroscopy frequency,hospital stay,Cobb′s angle,anterior vertebral height of the injured vertebrae,Visual Analog Scale(VAS)score,Oswestry Disability Index(ODI),and related complications were compared among the three groups.Results In all three groups,the anterior vertebral height of the injured vertebrae and Cobb′s angle were significantly improved postoperatively(P<0.05),with no significant differences among the three groups postoperatively(P>0.05).During the perioperative period,the percutaneous group had significantly longer surgical time and more frequent fluoroscopy compared to the other two groups,with statistical significance(P<0.05).The open group had significantly greater intraoperative blood loss and longer hospital stays compared to the other two groups,with statistical significance(P<0.05).Postoperative drainage volumes differed significantly among the three groups(P<0.05).Postoperative VAS scores and ODI values decreased compared to preoperative values in all three groups(P<0.05),and patients in the percutaneous and Wiltse groups had better postoperative VAS scores and ODI values than those in the open group(P<0.05).The open group experienced more surgical and comorbidity-related complications postoperatively,with statistical significance compared to the o

关 键 词：经皮微创 Wiltse入路 传统切开入路 老年 胸腰椎骨折 伤椎 植骨 

分 类 号：R687.32[医药卫生—骨科学] R683.2[医药卫生—外科学]