Comparison of efficacy between muscle space approach and posterior median approach in surgical treatment for single-segment thoracolumbar burst fractures
Objective To compare the clinical efficacy of muscle space approach(Wiltse approach)and traditional posterior median approach in the treatment of thoracolumbar single-segment burst fractures.Methods Seventy-three patients with thoracolumbar burst fractures were treated by pedicle screw placement through the injured vertebra from January 2015 to January 2018,including 44 cases treated through the Wiltse approach and 29 cases through the traditional posterior median approach.The injury classification and injury degree TLICS score＞4 points,and the preoperative spinal cord nerve function was FrankelE.The operation time,intraoperative blood loss,postoperative drainage volume,preoperative and postoperative creatine kinase,anterior vertebral height,kyphosis angle(Cobb angle),VAS score were compared between two groups.Results Of the 73 patients,65 patients were followed up for 16 to 45 months,with an average of(31±1.5)months.All the screws were in good position and no spinal cord injury occurred.There was no significant difference in vertebral height,Cobb angle,creatine kinase,and VAS score between the two groups before operation(P＞0.05).The operation time was shorter,the intraoperative blood loss and postoperative drainage volume were significantly less in Wiltse group than those in the traditional group(P＜0.001).There was no significant difference in the improvement rate of anterior vertebral height and kyphosis between the two groups after internal fixation(P＞0.05).The creatine kinase level after internal fixation in the Wiltse group was significantly lower than that in the traditional group(P＜0.05).The VAS score of low back pain after internal fixation in the Wiltse group was better than that in the traditional group(P＜0.05).At the last follow-up,the morphology of the multifidus muscle in the Wiltse group was normal,while the morphology of the multifidus muscle in the traditional group disappeared and was replaced by irregular scar tissue.Conclusion In the treatment of single-level thoracolumbar burst fractures,Wiltse approach has the advantages of shorter operation time,less trauma and bleeding,significant back pain relief,and faster postoperative recovery compared to traditional approach.
万方数据
维普
