经肌间隙入路内固定结合经椎弓根植骨治疗胸腰椎骨折.DOCVIP

Wiltse入路内固定结合经伤椎椎弓根植骨治疗胸腰椎骨折 戴 斌 沈海滨 李道龙 周克中 戴九明 祁 才 刘志东 张 兵 江苏省滨海县人民医院骨科 江苏 滨海 224500 摘要 目的：Wiltse入路内固定结合经椎弓植骨治疗胸腰椎骨折的临床疗效。方法2008年0月至201年月70例行后路复位内固定手术治疗的胸腰椎骨折，其中Wiltse入路内固定结合经椎弓根植骨34例Wiltse入路，后正中入路内固定后外侧植骨36例，观察手术时间，失血量，术前、术后1周、术后3个月及12个月VAS评分、椎体高度压缩率、伤椎Cobb角、内固定并发症，并进行比较分析。结果：平均随访1.6个月。Wiltse入路组与常规入路组手术时间比较无统计学差异。两组手术平均失血量前者明显低于后者，差异具有统计学意义（P0.0）。两组术前VAS评分无明显差异，但术后1周、3月VAS评分Wiltse入路经椎弓根植骨组明显低于常规入路后外侧植骨组。两组间手术前、术后1周、术后3个月椎体高度压缩率、Cobb角无统计学差异（P0.05）；术后12个月随访时内固定并发症发生率、椎体高度压缩率、Cobb角两组比较差异具有统计学意义（P0.05）。术后12月随访时Wiltse入路经椎弓根植骨组无内固定并发症发生，常规入路后外侧融合组出现3例断钉，2例螺钉退出，1例钉棒松动。（P0.0）结论：Wiltse入路内固定结合经椎弓椎植骨恢复椎体前中柱支撑，具有创伤小，术后恢复快，内固定并发症发生率伤椎高度丢失和后凸畸形治疗胸腰椎骨折Wiltse approach fixation with transpedicle bone graft treated thoracolumbar fracture DAI Bin 　SHENG Haibin LI Dao-long et al Department of Orthopaedic Surgery, The People’s Hospital of BinHai County Jiang-Su Province, BinHai 224500, China Abstract Objective: To retrospectively analyze the clinical effect of treatment to thoracolumbar fracture using Wiltse approach through the pedicle fixation with transpedicle bone graft. Mehtods: From June 2008 to June 2012, 70 patients with thoracolumbar fracture were treated by posterior reduction internal fixation. 34 cases were treated by Wiltse approach fixation with transpedicle bone graft（Wiltse approach group）, and conventional approach fixation with posterolateral bone graft were 36 cases（conventional approach group）. Mean following-up was 15.6 months. We compared the operative time, intraoperative blood loss, VAS scores, rate of vertebral height compression, vertebral Cobb angle and complications of internal fixation between two groups. Results: All of 70 cases were followed up, the average follow-up duration was 16.6 months with a range of 12-24 months. The operative time of two groups was no significant difference. The difference of blood loss and postoperative drainage volume Wiltse approach was significantly lower than the conventional approach was statistically