摘要
目的比较Wiltse入路经伤椎固定与跨伤椎固定治疗胸腰段爆裂骨折的临床疗效。方法对42例无神经损伤的胸腰椎爆裂骨折患者分别采用Wiltse入路跨伤椎4钉固定(A组,20例)与经伤椎单平面螺钉固定(B组,22例),观察两组手术时间、术中出血量、术后伤椎前缘高度比、矢状面Cobb角等指标。结果 A组随访12～18个月,B组随访12～16个月。两组手术时间、术中出血量比较差异均无统计学意义(P>0.05)。伤椎前缘高度比及矢状面Cobb角:两组术后1周、12个月与术前相比均改善明显(P<0.05),两组之间比较差异无统计学意义(P>0.05);术后12个月与术后1周相比,A组差异有统计学意义(P<0.05),B组差异无统计学意义(P>0.05);术后12个月伤椎前缘高度比及矢状面Cobb角维持B组优于A组(P<0.05)。结论Wiltse入路经伤椎单平面螺钉固定治疗胸腰段爆裂骨折创伤小、恢复快,较之跨伤椎4钉固定能更好地维持骨折的复位效果。
Objective To compare the clinical effect of injured level fixation and crossing injured vertebra fixation for thoracolumbar burst fracture through Wiltse approach. Methods There were 42 patients with thoracolumbar fracture without nerve injury,20 cases underwent crossing injured vertebra fixation by 4 screws（ group A）,22 cases were treated with additional transpedicular fixation at the fractured level by monoplanar screw（ group B）. The operative duration,blood loss volume,anterior vertebral height ratio,sagittal Cobb angle were observed. Results The group A and B was followed up for 12 ～ 18 months and 12 ～ 16 months,respectively. There were no significant differences in operative time and bleeding volume between two groups（ P 0. 05）. The vertebral anterior height ratio and sagittal Cobb angle of injured vertebra： compared with the preoperation,there were significant differences at 1 week,12 months after operation in both groups（ P 0. 05）,but no difference existed between group A and B（ P 0. 05）; compared with the postoperative 1 week,group A had significant differences after 12 months（ P 0. 05）,group B had not（ P 0. 05）; and at 12 months postoperation,group B was superior to group A（ P 0. 05）. Conclusions Injured level fixation by monoplanar screw for thoracolumbar burst fracture through Wiltse approach,which provides minimal invasion and quick recovery,is more effective than crossing injured vertebra 4 screws fixation in keeping reduction.
作者
宣涛
余润泽
申才良
于水
李勇
XUAN Tao, YU Run-ze, SHEN Cai-li- ang, YU Shui,LI Yong(Dept of Spine Surgery,Anhui No. 2 Provincial People＇s Hospital,Hefei,Anhui 230041, China)
出处
《临床骨科杂志》
2018年第4期409-412,共4页
Journal of Clinical Orthopaedics
