摘要
目的探讨经Wiltse入路结合伤椎双侧置钉短节段固定治疗胸腰椎中重度压缩的爆裂性骨折的临床效果。方法回顾性分析2015-01—2020-12昆明市中医医院骨伤科收治的56例中重度压缩胸腰椎的爆裂性骨折患者的临床资料。分为2组:短节段组31例实施经Wiltse入路结合伤椎双侧置钉短节段固定,经椎弓根充分植骨术;长节段组25例行传统后正中入路长节段跨伤椎固定,经椎弓根充分植骨术。比较2组患者的手术情况及临床疗效。结果短节段组的手术时间、术中出血量和软组织损伤程度,以及术后引流量和第7天的VAS评分均明显少(小)于长节段组,差异均有统计学意义(P<0.05)。术后随访3~36个月,2组均未发生断钉断棒、骨折愈合缓慢等并发症。术后3个月时2组患者的ODI评分、Cobb角及伤椎前缘高度差异无统计学意义(P>0.05)。结论经Wiltse入路结合伤椎双侧置钉短节段固定与传统后正中入路长节段跨伤椎固定治疗中重度椎体压缩的胸腰椎爆裂性骨折,均可获得满意的效果。但经Wiltse入路结合伤椎双侧置钉短节段固定具有手术时间短、术中出血量少和对软组织创伤小,以及患者疼痛轻等优势。
Objective To investigate the clinical effect of Wiltse approach combined with bilateral screw fixation in the treatment of thoracolumbar burst fracture with severe compression.Methods Clinical data of 56 patients with thoracolumbar burst fractures with moderate and severe compression admitted to the Orthopedics department of Kunming Hospital of Traditional Chinese Medicine from January 2015 to December 2020 were retrospectively analyzed,and they were divided into 2 groups.In the short segment group,31 patients received short segment fixation via Wiltse approach combined with bilateral screw fixation of injured vertebrae and full pedicle bone grafting.In the long segment group,25 patients underwent traditional median posterior approach with long segment transvertebral fixation and full pedicle bone grafting.The operation and clinical efficacy of the two groups were compared.Results The operative time,intraoperative blood loss,soft tissue injury degree,postoperative drainage and VAS score on day 7 in the short segment group were significantly lower than those of the long segment group,with statistical significance(P<0.05).There were no complications such as broken screw and rod,slow fracture healing and so on in both groups during 3~36 months follow-up.Three months after surgery,there were no significant differences in ODI score,Cobb Angle and anterior height of injured vertebrae between 2 groups(P>0.05).Conclusion The treatment of thoracolumbar burst fractures with moderate and severe vertebral compression by Wiltse approach combined with bilateral pedicle screw fixation and traditional posterior midline approach with long segmental transvertebral fixation can achieve satisfactory results.However,short segmental fixation via Wiltse approach combined with bilateral screw placement in injured vertebrae has the advantages of short operation time,less intraoperative blood loss,less trauma to soft tissue,and less pain for patients.
作者
李鉴
李德光
江波
李枝鑫
Li Jian;Li Deguang;Jiang Bo;Li Zhixin(Department of Orthopedics and Traumatology,Kunming Hospital Of Traditional Chinese Medicine,Kunming,650000,China)
出处
《河南外科学杂志》
2022年第3期20-24,共5页
Henan Journal of Surgery
基金
昆明市卫生科技人才培养项目暨“十百千”工程培养计划(2020-SW-77)。
关键词
胸腰椎爆裂性骨折
椎旁肌间隙入路
短节段
植骨
Thoracolumbar burst fracture
Paravertebral space approach
A short segment
Bone graft
