Wiltse入路与传统后正中入路治疗胸腰椎骨折的对比研究

发布时间：2018-05-27 19:57

本文选题：胸椎骨折 + 腰椎骨折　；参考：《石河子大学》2015年硕士论文

【摘要】：目的:比较经Wiltse入路与传统后正中入路行切开复位内固定术,治疗胸腰椎椎体骨折的临床疗效。方法:对2012年7月~2013年7月,住院手术治疗胸腰椎骨折患者62例,男40例,女22例;年龄范围为23~78岁,平均年龄45.97岁。手术治疗病例均为脊髓损伤分级,Frankel分级为E级的压缩型骨折、爆裂型骨折无神经症状,且不需后路椎板减压的患者。随机将需要手术治疗的患者分为传统后正中入路组和Wiltse入路组,记录并比较两入路所需手术时间、术中出血量、术后引流量、住院时间、住院总费用、术前Cobb角与手术复位后Cobb角度改变、术前1天术后3月以及术后1年疼痛视觉模拟量表(Visual analogue scale VAS)评分,以及术后随访1年的下腰痛功能障碍指数(Oswestry disability index ODI)评分。结果:经Wiltse入路组在手术时间、术中出血量、术后引流量、住院时间、住院总费用、术后3月术后1年视觉疼痛VAS评分上较传统后正中入路组有明显优越性,术后1年下腰痛功能障碍指数ODI评分无明显差异,术前Cobb角与术后Cobb角变化差别无统计学意义,(P0.05)。结论:在掌握手术适应症的前提下Wiltse入路治疗胸腰段椎体骨折,具有医源性损伤小、手术耗时少、置钉方便、术中出血少、术后并发症少,符合脊柱微创手术理念,是一种值得临床推广的术式。
[Abstract]:Objective: to compare the clinical effect of open reduction and internal fixation via Wiltse approach and traditional posterior median approach in the treatment of thoracolumbar vertebral body fracture. Methods: from July 2012 to July 2013, 62 patients (40 males and 22 females) with thoracolumbar fractures were treated by surgical treatment, with an average age of 45.97 years (23 ~ 78 years). All cases were treated with compression fracture of spinal cord injury grade Frankel grade E, burst fracture without nerve symptom and without posterior lamina decompression. Patients in need of surgical treatment were randomly divided into two groups: the traditional posterior median approach group and the Wiltse approach group. The operation time, intraoperative bleeding volume, postoperative drainage volume, hospitalization time, total hospitalization cost were recorded and compared. The changes of preoperative Cobb angle and Cobb angle after surgical reduction, visual analogue scale of pain 1 day before operation, visual analogue scale of pain 1 year after operation, and Oswestry disability index ODI) score of low back pain dysfunction index after 1 year follow up. Results: the operation time, intraoperative bleeding volume, postoperative drainage volume, hospital stay time, total hospitalization cost and VAS score of visual pain 1 month after operation in the Wiltse approach group were significantly superior to those in the traditional posterior median approach group. There was no significant difference in ODI score of low back pain dysfunction index 1 year after operation. There was no significant difference between preoperative Cobb angle and postoperative Cobb angle (P 0.05). Conclusion: the treatment of thoracolumbar vertebral fracture with Wiltse approach under the condition of mastering the indication of operation has the advantages of less iatrogenic injury, less operation time, convenient nail placement, less intraoperative bleeding and less postoperative complications, which is in line with the principle of minimally invasive spinal surgery. It is a kind of operation that is worth popularizing clinically.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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