Wiltse入路与经皮椎弓根固定单节胸腰椎骨折比较△（开放获取）

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

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 dWiltse 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。

Abstract:

[Objective] To compare the clinical efficacy of Wiltse approach pedicle screw fixation (WAPSF) versus percutaneous pedi-cle screw fixation (PPSF) in the treatment of single-level thoracolumbar fracture. [Methods] A retrospective study was conducted on 97 pa-tients who received surgical treatment for single-segment thoracolumbar fracture without nerve injury in our department from January 2013to December 2020. According to the preoperative doctor-patient exchange, 51 patients underwent WAPSF, while other 46 patients werewith PPSF. The data of perioperative period, follow-up and imaging were compared between the two groups. [Results] The operation wassuccessfully 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 yu-an 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 ofimaging, there was no significant difference in the accuracy of screw placement between the two groups (P＞0.05). The local kyphotic Cobbangle decreased significantly (P＜0.05), while the percentage of anterior vertebra height increased significantly in both groups postoperative-ly compared with those preoperatively (P＜0.05). The WAPSF group proved significantly superior to the PPSF group regarding the local ky-photic 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 pedicle screw are minimally invasive fixation of thoracolumbar frac-tures, and do achieve satisfactory clinical consequence. In contrast, the Wiltse approach is less time-consuming, less doctor and patient ra-diation exposure, less hospitalization costs, and more satisfactory in improving thoracolumbar kyphosis angle and restoring the height of the injured vertebrae.