Analysis Of The Advantages Of Wiltse Approach Reduction And Internal Fixation In The Treatment Of Low Lumbar Fractures With Traumatic Spinal Stenosis

Objective:A retrospective analysis was conducted on the data of 49 cases of non-neurotic lower lumbar fractures with traumatic spinal stenosis in china-japan union hospital of jilin university.To compare the clinical efficacy of the Wiltse approach and the traditional posterior median approach for the treatment of non-neurotic lower lumbar fractures with traumatic spinal stenosis,to provide a basis for the clinical treatment of the disease.Methods:The clinical data of 49 qualified patients with lumbar fracture who underwent fracture reduction and internal fixation without neurological symptoms with traumatic spinal stenosis in the lower lumbar spine of the same medical group of our hospital from January 2010 to October 2019 were collected.Include:general clinical data(age,sex),Clinical symptoms,specialist examination,surgical segmental distribution,imaging examination(frontal and lateral lumbar X-ray,lumbar CT,etc.).All patients were randomly divided into two groups,one was the traditional posterior median approach group and the other was the Wiltse approach group.There were 28 patients in the traditional posterior median approach group and 21 patients in the Wiltse group.Perioperative indicators(operation time,intraoperative blood loss,postoperative drainage,postoperative length of stay,complications)were compared between the two groups.VAS score of lumbar back pain,anterior and posterior diameter of CT vertebral canal in median sagittal position,posterior convex Angle of injured vertebra,and loss rate of vertebral body height before,after and 1 year after surgery were statistically analyzed to compare the statistical significance of the differences.Results:A total of 56 patients were included in this study,of which 7 were lost to follow-up and 49 were successfully followed up.The mean age of the 49 patients was(25.16±4.35)years old(16-34 years old),there were25 males and 24 females in the Wiltse approach group.Compared with the posterior median approach group,the operation time,intraoperative blood loss,postoperative drainage volume and length of stay in the Wiltse approach group were all improved(P<0.05).There was no statistical difference in the incidence of postoperative complications(P>0.05).Lumbar back pain VAS score was lower in the Wiltse group(P<0.05).After 1 year of follow-up,VAS scores of patients in both groups showed that the Wiltse approach group was lower than the posterior median approach group(P<0.05).In terms of imaging findings,there was no statistical difference between the Wiltse approach group and the posterior median approach group before,after and 1 year after the comparison of anterior and posterior sagittal diameter of the CT spinal canal,posterior convex Angle of the injured vertebra,and vertebral height loss rate(P>0.05).Conclusion:For patients with spinal stenosis caused by fractures of the lower lumbar spine without neurological symptoms.Both the Wiltse approach and the traditional posterior median approach can achieve a good reduction effect on the vertebral fracture of patients.According to the imaging measurement and comparison in this study,the two methods can achieve the same reduction effect.Patients with Wiltse approach had relatively less intraoperative blood loss and postoperative drainage,shorter average hospital stay,and relatively less postoperative lower back pain,which could achieve the same effect with less trauma.