摘要
目的比较经皮置钉及改良后Wiltse入路两种术式联合短节段椎弓根螺钉固定治疗胸腰椎骨折的临床疗效.方法选取本院2017年7月—2020年7月收治的83例胸腰段脊柱骨折患者为研究对象,以电脑随机数字表法分为经皮组41例与改良后Wiltse入路组42例.经皮组采用经皮置钉术式联合短节段椎弓根螺钉治疗,改良后Wiltse入路组采用改良后Wiltse入路术式联合短节段椎弓根螺钉治疗.两组均术后随访1个月.比较两组的临床疗效,各项围术期指标水平,手术前后疼痛视觉模拟评分(VAS)及并发症发生情况.结果两组术后3 d、末次随访时的伤椎椎体前缘高度比值及Cobb角比较,差异无统计学意义(P>0.05).经皮组的手术时长为(91.32±6.23)min,长于改良后Wiltse入路组的(64.02±3.84)min,术中失血量及住院时长分别为(74.29±8.13)mL、(7.49±1.34)d,均少于改良后Wiltse入路组的(213.85±14.25)mL、(12.06±1.55)d,组间差异有统计学意义(P<0.05).经皮组术后3、7 d的VAS评分分别为(2.06±0.53)分、(2.05±0.45)分,均低于改良后Wiltse入路组的(2.29±0.52)分、(2.71±0.66)分,组间差异有统计学意义(P<0.05).两组的切口感染、内固定松动或断裂、骨折不愈合及进行性后凸畸形的发生率比较,差异无统计学意义(P>0.05).结论经皮置钉及改良后Wiltse入路两种术式联合短节段椎弓根螺钉治疗胸腰段脊柱骨折的效果相当,经皮置钉的术中失血量较少,住院时间较短,而改良后Wiltse入路手术时间较短,可操作性较强.
Objective To compare the clinical efficacy of percutaneous screw placement and modified Wiltse approach combined with short segment pedicle screw fixation for thoracolumbar fracture.Methods A total of 83 patients with thoracolumbar spinal fractures admitted to the hospital from July 2017 to July 2020 were selected as the research objects,and were divided into 41 cases in a percutaneous group and 42 cases in an modified Wiltse approach group by computer random number table method.The percutaneous group was treated with percutaneous screw placement combined with short segment pedicle screws,and the modified Wiltse approach group was treated with modified Wiltse approach combined with short segment pedicle screws.Both groups were followed up for 1 month.The clinical efficacy,perioperative indexes,visual analogue scale(VAS)of pain before and after surgery and complications were compared between the two groups.Results There were no significant differences in anterior margin height ratios and Cobb angles between the two groups at 3 d after surgery and the last follow-up(P>0.05).The operative duration of the percutaneous group was(91.32±6.23)min,longer than(64.02±3.84)min of the modified Wiltse approach group,the intraoperative blood loss and hospital stay were(74.29±8.13)mL and(7.49±1.34)d,respectively,lower than(213.85±14.25)mL and(12.06±1.55)d of the modified Wiltse approach group,the differences between groups were statistically significant(P<0.05).The VAS scores of the percutaneous group at 3 and 7 d after surgery were(2.06±0.53)points and(2.05±0.45)points,respectively,lower than(2.29±0.52)points and(2.71±0.66)points of the modified Wiltse approach group,the differences between groups were statistically significant(P<0.05).There were no significant differences in the incidences of incision infection,internal fixation loosening or fracture,fracture nonunion and progressive kyphosis between the two groups(P>0.05).Conclusion Percutaneous screw placement and modified Wiltse approach combined with short segment pedicle screw have similar effects in the treatment of thoracolumbar spine fractures.Percutaneous screw placement has less intraoperative blood loss and shorter hospital stay,while the modified Wiltse approach has shorter operative time and better operability.
作者
吴长青
张元洲
章瑞锋
刘勇占
WU Changqing;ZHANG Yuanzhou;ZHANG Ruifeng;LIU Yongzhan(Department of Orthopaedics and Traumatology,No.951 Hospital,Korla Xinjiang,841000,China)
出处
《反射疗法与康复医学》
2022年第4期46-50,共5页
Reflexology And Rehabilitation Medicine
关键词
胸腰段脊柱骨折
经皮置钉
改良后Wiltse入路
短节段椎弓根螺钉
疗效
Thoracolumbar spinal fracture
Percutaneous nail placement
Modified Wiltse approach
Short segment pedicle screw
Curative effect
