Wiltse入路与经皮椎弓根固定单节胸腰椎骨折比较  

Wiltse approach versus percutaneous pedicle screw fixation of single-segment thoracolumbar fracture

作　　者：张涛 刘华 高红亮 李松凯 ZHANG Tao;LIUHua;GAO Hong-liang;LI Song-kai(The 940th Hospital,Joint Logistics Support Force of PLA,Lanzhou,Gansu 730050,China)

机构地区：[1]联勤保障部队第九四〇医院脊柱外科,甘肃兰州730050

出　　处：《中国矫形外科杂志》2025年第5期392-397,共6页Orthopedic Journal of China

基　　金：甘肃省重点研发计划项目(编号:21YF1FA179);甘肃省卫生健康行业科研项目(编号:GSWSKY2020-05);军队医学科技青年培育计划项目(编号:2023HQZZ-08,2021yxky008,2023YXKY021)。

摘　　要：[目的]比较Wiltse入路与经皮椎弓根固定治疗单节段胸腰段骨折的疗效。[方法]回顾性分析2013年1月—2020年12月本科收治的无神经损伤胸腰段骨折97例患者的临床资料。根据医患沟通结果,51例采用Wiltse入路(Wiltse组),46例采用经皮入路(经皮组)。比较两组围手术期、随访及影像结果。[结果]两组患者均顺利完成手术。Wiltse组手术时间[(75.5±8.6)min vs(103.5±9.0)min,P<0.001]、术中透视次数[(6.4±0.9)次vs(15.4±1.6)次,P<0.001]、住院费用[(4.3±0.3)万元vs(5.0±0.2)万元,P<0.001]显著优于经皮组,但前者的切口总长度显著大于后者[(7.0±0.7)cm vs(6.3±0.5)cm,P<0.001]。术后第1 d Wiltse组CK水平显著低于经皮组[(155.7±9.9)U/L vs(174.3±15.8)U/L,P<0.001]。随时间推移,两组术后腰痛VAS、ODI评分均显著减少(P<0.05),术后3 d经皮组ODI评分显著少于Wiltse组(P<0.05)。影像方面,两组患者置钉准确率比较差异无统计学意义(P>0.05)。与术前相比,两组患者术后各时间点局部后凸Cobb角均显著减小(P<0.05),伤椎前缘高度百分比显著增加(P<0.05)。术后3 d、内固定取出前、后,Wiltse组局部后凸Cobb角均显著小于经皮组(P<0.05),术后3 d Wiltse组伤椎前缘高度百分比显著大于经皮组(P<0.05)。[结论]Wiltse入路及经皮内固定术均是胸腰段骨折微创术式,可获得满意临床疗效。相比之下,Wiltse入路手术耗时更短、医患射线暴露更少、住院费用更低,改善胸腰段后凸角及恢复伤椎高度更满意。[Objective]To compare the clinical efficacy of Wiltse approach pedicle screw fixation(WAPSF)versus percutaneous pedicle screw fixation(PPSF)in the treatment of single-level thoracolumbar fracture.[Methods]A retrospective study was conducted on 97 patients who received surgical treatment for single-segment thoracolumbar fracture without nerve injury in our department from January 2013 to December 2020.According to the preoperative doctor-patient exchange,51 patients underwent WAPSF,while other 46 patients were with PPSF.The data of perioperative period,follow-up and imaging were compared between the two groups.[Results]The operation was successfully completed in both groups.The WAPSF group was significantly better than the PPSF group in operation time[(75.5±8.6)min vs(103.5±9.0)min,P<0.001],intraoperative fluoroscopy times[(6.4±0.9)vs(15.4±1.6),P<0.001],the hospitalization cost[(4.3±0.3)10 k yuan vs(5.0±0.2)10 k yuan,P<0.001],but the former had significantly longer total incision length than the latter[(7.0±0.7)cm vs(6.3±0.5)cm,P<0.001].In addition,the WAPSF group had significantly lower blood creatine kinase(CK)than the PPSF group 1 day after surgery[(155.7±9.9)U/L vs(174.3±15.8)U/L,P<0.001].The VAS for back pain and ODI scores significantly decreased in both groups with time(P<0.05),and ODI scores in WAPSF group were significantly higher than that in the PPSF group 3 days after surgery(P<0.05).In term of imaging,there was no significant difference in the accuracy of screw placement between the two groups(P>0.05).The local kyphotic Cobb angle decreased significantly(P<0.05),while the percentage of anterior vertebra height increased significantly in both groups postoperatively compared with those preoperatively(P<0.05).The WAPSF group proved significantly superior to the PPSF group regarding the local kyphotic Cobb angle at all time points after operation(P<0.05),and the percentage of anterior vertebral height 3 days after operation(P<0.05).[Conclusion]Both Wiltse approach pedicle screw and percutaneous

关 键 词：胸腰段骨折 微创手术 WILTSE 入路 经皮螺钉内固定术 

分 类 号：R683.2[医药卫生—骨科学]