Wiltse入路与经皮微创椎弓根螺钉内固定术治疗胸腰椎骨折的临床效果比较

A comparative study on the clinical effects of Wiltse approach and percutaneous pedicle screw internal fixation in the treatment of thoracolumbar fractures

中文关键词:  胸腰椎骨折  Wiltse入路椎弓根螺钉内固定  经皮微创椎弓根螺钉内固定  微创手术  脊柱

英文关键词:Thoracic and lumbar fracture  Wiltse approach with pedicle screw fixation  Percutaneous pedicle screw fixation  Minimally invasive surgery  Spine

中文摘要:

  【摘要】 目的：回顾性比较Wiltse入路与经皮微创椎弓根螺钉内固定术的临床效果。方法：选取2024年7月～2025年6月本院收治并接受椎弓根螺钉内固定术的胸腰椎（T10～L4）骨折患者，筛选后根据患者手术的方式分为WAPSF（Wiltse approach pedicle screw fixation）组和PPSF（percutaneous pedicle screw fixation）组。本研究共纳入68例胸腰椎骨折患者，包括WAPSF组38例，PPSF组30例。记录患者一般信息，包括患者外伤原因、性别、年龄、BMI、骨密度、骨折节段及基础疾病情况；手术情况，包括切口长度、手术时间、失血量、C型臂X线机曝光次数、手术费用以及围手术期并发症；及术后各项评分与影像学资料，即椎体高度比、前缘椎体高度比、椎体角和局部Cobb角。对收集的数据进行统计分析。结果：WAPSF组患者手术切口总长度更短，术中出血量更少（54.34mL vs 81.83mL，P<0.01），术后隐性出血约为PPSF组的1/2（172.7mL vs 349.1mL，P<0.05），术中透视次数更少（7.95次 vs 12.23次，P<0.01），手术费用更低（9038元 vs 10451元，P<0.01）。两组患者术后VAS评分、ODI及影像学指标明显改善（P<0.01）。椎体压缩不足20%的患者中，WAPSF组术后椎体高度比更大，而术后椎体角更小（P<0.05）；椎体压缩20%以上的患者中，PPSF组手术前后的局部Cobb角无统计学差异（P>0.05）。结论：Wiltse入路与经皮微创椎弓根螺钉内固定术对胸腰椎骨折都具有良好的手术效果。Wiltse入路在手术切口总长度、术中出血量、术后隐性出血、透视次数、手术费用方面更具优势。对于轻度压缩骨折，WAPSF入路能够对伤椎进行更精确、更有力的撑开复位。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacies of the Wiltse approach pedicle screw fixation(WAPSF) and percutaneous pedicle screw fixation(PPSF) in treating thoracolumbar fractures. Methods: Patients with thoracolumbar(T10-L4) fractures who underwent pedicle screw fixation from July 2024 to June 2025 were selected. Eligible patients were divided into a WAPSF group and a PPSF group based on the surgical approach. A total of 68 patients diagnosed with thoracolumbar fractures were included in this study, comprising 38 patients in the WAPSF group and 30 in the PPSF group. General data such as causes of trauma, gender, age, body mass index(BMI), bone mineral density(BMD), fractured vertebra, and comorbidities were recorded. Operative parameters including incision length, operation duration, blood loss, fluoroscopy times of C-arm X-ray machine, surgical cost, and perioperative complications were collected. Postoperative outcomes including postoperative hidden blood loss, visual analogue scale(VAS) scores, Oswestry disability index(ODI), as well as radiographic parameters including vertebral height ratio(VHR), anterior vertebral height ratio(AVHR), vertebral body angle(VBA), and local Cobb angle(LCA) were also collected. The data collected were statistically analyzed. Results: The WAPSF group was shorter than the PPSF group in surgical incision, less in intraoperative blood loss(54.34mL vs 81.83mL, P<0.01) and postoperative hidden blood loss(172.7mL vs 349.1mL, P<0.05), fewer fluoroscopy times during surgery(7.95 vs 12.23, P<0.01), and lower surgical costs(9038 yuan vs 10451 yuan, P<0.01). Postoperatively, both groups showed significant improvements in VAS scores, ODI, and radiographic parameters. In patients with vertebral body compression less than 20%, the WAPSF group showed a greater VHR and a smaller VBA after operation. In patients with vertebral body compression over 20%, no obvious difference was found between the preoperative and postoperative LCA in the PPSF group(P>0.05). Conclusions: Both the WAPSF and PPSF can achieve favorable clinical outcomes for thoracolumbar fractures. Wiltse approach offers advantages in terms of total incision length, intraoperative blood loss, postoperative hidden blood loss, fluoroscopy frequency, and surgical cost. For mild compression fractures, it allows for more precise and effective distraction reduction of the injured vertebra.