Wen Ganjun, Jiang Diqin, Zhou Zhisen, Teng Fanwen, Zhao Yunfang
Department of Orthopedics, Dongguan East Central Hospital, Dongguan Guangdong, 523573, P. R. China.
The First Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Mar 15;36(3):310-314. doi: 10.7507/1002-1892.202110030.
To investigate the effectiveness of Wiltse approach with fulcrum reduction technique and pedicle internal fixation in the treatment of AO-A type thoracolumbar fractures.
The clinical data of 16 patients with AO-A type thoracolumbar fractures treated with Wiltse approach with fulcrum reduction technique and pedicle internal fixation between September 2013 and January 2019 were retrospectively analyzed. There were 9 males and 7 females, the age ranged from 38 to 60 years, with an average age of 50.7 years. Causes of injury included 9 cases of falling from height, 3 cases of traffic accidents, 3 cases of falling, and 1 case crushed by heavy objects. Fractured segment involved T in 2 cases, T in 5 cases, L in 7 cases, and L in 2 cases. There were 6 cases of type A1, 3 cases of type A2, 5 cases of type A3, and 2 cases of type A4 according to AO fracture classification. The operation time, intraoperative blood loss, and removal time of internal fixator were recorded. Before operation, immediately after operation, before and after removal of internal fixator, the local kyphotic angle (LKA), anterior vertebral height (AVH), and posterior vertebral height (PVH) of fractured vertebral body were measured; visual analogue scale (VAS) score of back pain were evaluated before operation, at 3 days after operation, before and after removal of internal fixator.
The operation time of the patients was 50-95 minutes, with an average of 70.7 minutes; the intraoperative blood loss was 50-230 mL, with an average of 132.9 mL; the internal fixator was removed after 18-30 months, with an average of 23.6 months. All patients were followed up 20-32 months, with an average of 25.6 months. No incision infection, hematoma, and other surgery-related complications, and internal fixator rupture residual complications occurred. All 16 patients achieved satisfactory reduction results. Immediate postoperative LKA, AVH, and PVH were significantly improved when compared with preoperative ones ( <0.05). There was a certain degree of reduction loss before internal fixator removal, and the difference in LKA was significant ( <0.05), but the difference in AVH and PVH were not significant ( >0.05). There was a certain degree of reduction loss after internal fixator removal, but only the difference in AVH was significant ( <0.05), and there was no significant difference in LKA and PVH ( >0.05). The VAS score of the back pain significantly improved at 3 days after operation and before internal fixator removal when compared with preoperative score ( <0.05). The pain after internal fixator removal was significantly worse than that before internal fixator removal ( <0.05).
The Wiltse approach with fulcrum reduction technique and pedicle internal fixation in the treatment of AO-A thoracolumbar fractures has a short operation time, less intraoperative blood loss, and the posterior soft tissue and other structures are well protected during the operation. It can provide satisfactory clinical reduction results.
探讨Wiltse入路结合支点复位技术及椎弓根内固定治疗AO - A型胸腰椎骨折的有效性。
回顾性分析2013年9月至2019年1月采用Wiltse入路结合支点复位技术及椎弓根内固定治疗的16例AO - A型胸腰椎骨折患者的临床资料。其中男性9例，女性7例，年龄38～60岁，平均年龄50.7岁。受伤原因包括高处坠落9例、交通事故3例、摔倒3例、重物挤压1例。骨折节段涉及T12 2例、T11 5例、L1 7例、L2 2例。根据AO骨折分类，A1型6例，A2型3例，A3型5例，A4型2例。记录手术时间、术中出血量及内固定取出时间。术前、术后即刻、内固定取出前后，测量骨折椎体的局部后凸角（LKA）、椎体前缘高度（AVH）及椎体后缘高度（PVH）；评估术前、术后3天、内固定取出前后的背痛视觉模拟评分（VAS）。
患者手术时间50～95分钟，平均70.7分钟；术中出血量50～230 mL，平均132.9 mL；内固定在18～30个月取出，平均23.6个月。所有患者随访20～32个月，平均25.6个月。未发生切口感染、血肿等手术相关并发症及内固定断裂残留并发症。16例患者均获得满意的复位效果。术后即刻LKA、AVH及PVH与术前相比均显著改善（P<0.05）。内固定取出前有一定程度的复位丢失，LKA差异有统计学意义（P<0.05），但AVH和PVH差异无统计学意义（P>0.05）。内固定取出后有一定程度的复位丢失，但仅AVH差异有统计学意义（P<0.05），LKA和PVH差异无统计学意义（P>0.05）。术后3天及内固定取出前背痛VAS评分与术前相比显著改善（P<0.
