| Objective To investigate the clinical efficacy of two minimally invasive surgical methods of Wiltse approach pedicle screw fixation and percutaneous approach pedicle screw fixation in patients with single-level thoracolumbar fracture without nerve injury.The advantages and disadvantages of the two surgical methods were compared comprehensively to provide reference for clinicians to choose surgical methods.Methods A total of 46 patients with single-level thoracolumbar fracture without nerve injury admitted to Hefei Second People’s Hospital from September 2019 to January2021 were retrospectively analyzed,including 22 patients who underwent Wiltse approach pedicle screw fixation（Wiltse group）and 24 patients who underwent percutaneous approach pedicle screw fixation（percutaneous group）.Incision length,operation time,screw placement accuracy,Number of X-ray fluoroscopy,intraoperative blood loss,serum creatine kinase（CK）value at 1,3 and 5 d after surgery,VAS score at3 d after surgery and last follow-up,anterior margin height ratio of injured vertebra and kyphosis Cobb Angle,Spontaneous potential of paravertebral muscles（multifidus and longissimus）and cross-sectional area of multifidus muscle 1 month after operation were compared between 2 groups.Results A total of 46 cases that met the inclusion criteria were followed up for 8～15months,with an average of（11.2±2.1）months.No wound infection,pedicle screw breakage or rod breakage occurred in any of the patients.By comparing the perioperative data of the two groups,it was found that the Wiltse group had the advantages of less operation time（t=-5.427）and fewer X-ray fluoroscopy times（t=-14.4）compared with the percutaneous group,with statistically significant differences（P<0.05）.However,the Wiltse group had more intraoperative blood loss（t=3.783）and higher serum CK value on the 1st and 3rd day after surgery（t=2.273,t=3.047）,which was statistically significant compared with the percutaneous group（P<0.05）.Most of the serum CK values of the two surgical methods returned to normal level 5 days after surgery,The serum CK value of the Wiltse group was 45～265（150±67）U/L,and that of the percutaneous group was 40～240（142±63）U/L,and there was no statistical significance between the two groups（P>0.05）.There were no significant differences in incision length,VAS scores 3 d after surgery and at the last follow-up between the two groups（P>0.05）.Imaging examination results showed that a total of132 screws were inserted in the Wiltse group,of which 108 met the grade 0 standard,19met the grade 1 standard,and 5 met the grade 2 standard.A total of 144 screws were installed in percutaneous group,of which 131 were in conformity with grade 0 standard,10 were in conformity with grade 1 standard and 3 were in conformity with Grade 2standard.Accuracy of nail placement in Wiltse group was 81.8%.The accuracy of nail placement in percutaneous group was 91.0%,and the difference was statistically significant（X~2=4.971,P<0.05）.There were no significant differences in anterior margin height ratio and kyphosis Cobb Angle between the two groups at 3 d after surgery and the last follow-up（P>0.05）.One month after surgery,the cross-sectional area of multifidus muscle in the Wiltse group was 161～495（316±98）mm~2,and that in the percutaneous group was 186～542（346±101）mm~2.The cross-sectional area of multifidus muscle in both groups decreased to varying degrees compared with that before surgery.Although the cross-sectional area of multifidus muscle in the Wiltse group decreased relatively more,there was no statistical significance between the two groups（P>0.05）.There was no obvious spontaneous potential in paravertebral EMG in both groups one month after surgery.Conclusion According to our research on Wiltse approach and percutaneous approach for thoracolumbar fracture patients without single level nerve injury,both Wiltse approach and percutaneous approach can effectively restore the anterior height of injured vertebra and correct cobb Angle,both of which are safe minimally invasive surgical methods.Although the Wiltse approach has short operative time and fewer intraoperative fluoroscopy times,percutaneous approach has less intraoperative blood loss and better effect on improving the accuracy of screw placement. |
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