经Wiltse肌间入路长节段内固定联合椎板间有限减压治疗胸腰段爆裂骨折的临床疗效  

Clinical Study of Posterior Long Segment Pedicle Screw Fixation Combined with Limited Interlaminar Decompression through Wiltse Paraspinal Approach for Thoracolumbar Burst Fractures

作　　者：吴龙[1] 翟鹏 赵鑫 庞龙[1] 李鹏[1] WU Long;ZHAI Peng;ZHAO Xin;PANG Long;LI Peng(Third Department of Orthopedics,General Hospital of Ningxia Medical University,First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China;Department of Anesthesia and Perioperative Medicine,General Hospital of Ningxia Medical University,First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院骨三科,宁夏医科大学第一临床医学院,银川750004 [2]宁夏医科大学总医院麻醉与围术期医学科,宁夏医科大学第一临床医学院,银川750004

出　　处：《宁夏医科大学学报》2024年第9期945-949,共5页Journal of Ningxia Medical University

摘　　要：目的对比经Wiltse肌间入路长节段内固定联合椎板间有限减压与传统入路固定减压治疗胸腰段爆裂骨折的临床疗效。方法选择42例单节段胸腰段爆裂骨折手术患者,依据入路的不同将患者分为经Wiltse肌间入路组(n=20)及传统组(n=22),记录并比较两组患者手术时间、术中出血量等围术期指标;手术前后伤椎椎体前缘高度比和矢状位Cobb角的变化;术前及术后3个月神经功能恢复情况。结果经Wiltse肌间入路组患者的手术时间、术中出血量、术后引流量、术后住院时间、术后VAS评分均优于对照组(P均<0.05)。两组患者术后矢状位Cobb角及伤椎椎体前缘高度均较术前改善(P均<0.05)。两组患者术后3个月Frankel分级比较,差异无统计学意义(P>0.05)。结论在采取长节段椎弓根钉内固定减压治疗胸腰段爆裂骨折的患者中,与传统入路相比,经Wiltse肌间入路置钉联合有限减压具有手术时间短、出血少、保护椎旁肌、最大限度保留后方稳定结构的优势。Objective To compare the clinical efficacy of long segment pedicle screw fixation combined with limited decompression between the Wiltse paraspinal approach and traditional open approach for the treatment of thoracolumbar burst fractures.Methods Clinical data of 42 patients with thoracolumbar burst fractures undergoing long segment pedicle screw fixation combined with laminectomy decompression from January 2019 to March 2022 in the Third Department of Orthopedics of General Hospital of Ningxia Medical University were retrospectively studied.Among them,20 cases underwent posterior long segment pedicle screw fixation through Wiltse paraspinal approach combined with minimal invasive laminectomy decompression(Mini-group),and 22 cases underwent posterior long segment pedicle screw fixation through traditional open posterior approach combined with extensive laminectomy decompression(traditional-group).Perioperative information was recorded and analyzed respectively,such as the operation time,intraoperative blood loss,postoperative drainage,the Cobb angle,height of injured vertebral body,perioperative complications,VAS score and Frankel grade.Results The mean operation time,intraoperative blood loss,postoperative drainage,postoperative hospital stays,postoperative VAS score in Mini-group were significantly better than those in traditional-group.The Cobb angle,and height of injured vertebral body in two groups were significant improved in both groups after surgery compared to before,but there was no statistically significant difference between two groups(P all<0.05).The Frankel grading of the two groups 3 months after surgery was no statistically significant difference between the groups(P>0.05).Conclusion Posterior long segment pedicle screw fixation through Wiltse paraspinal approach combined with minimal invasive laminectomy can reduce intraoperative blood loss,shorten operation time,and reduce paraspinal muscle damage.Meanwhile,it preserved rear stability structure to the maximum extent.

关 键 词：Wiltse肌间入路 胸腰段爆裂骨折 长节段 椎弓根钉内固定 有限减压 

分 类 号：R687.3[医药卫生—骨科学]