Contrast Study On The Effects Of Paravertebral Muscle Between Wiltse Paraspinal Approach And Conventional Approach With Vertebral Pedicle Screw System In Treatment Of The Thracolumbar Vertebral Fracture

Objective: To compare short-term change of paraspinal muscle between wiltseparaspinal and conventional approach pedicle screw fixation in the treatment ofthoracolumbar fractures.Methods: According to the research standard,62cases of thoracolumbar fracturepatients were divided into2groups randomly, according to the gender and number of patients.31patients with odd number were adopted into the Wiltse paraspine approach group,31patients with even number were adopted into traditional approach group.Creatine phosphatekinase (CPK) of all the patients was measured preoperative and at the day1,3,5,7aftersurgery. The visual analogue scale (VAS) and ODI scores were evaluated1-day preoperativeand at1-month,3-month and6-month after operation. Evaluate the electromyography (EMG)of the paraspinal muscle at1-month,3-month and6-month after operation. And evaluate theduration of operation, intraoperative blood loss, postoperative drainage, postoperativeambulation time and hospital stays in the perioperative period. Statistic difference waschecked with SPSS17.0.Results: Among the62cases of patients,42cases were followed up,20cases were lost.Visual analogue scale(VAS) and Oswestry disability index (ODI) between pre-operation andpost-operation follow-up in the two groups were significantly different(P<0.05).There waslower index of serum level of CPK in Wiltse paraspinal approach group(P<0.05). In the studyof EMG when patients resting properative1-month,3-month and6-month, the results of Wiltse paraspine approach group showed that the number of patients with abnormalelectromyography signal were6,4,2. While in the traditional approach group is21. Thedifference between the two groups were significant (P<0.05).The intraoperative blood loss,postoperative ambulation time were significantly differenct between the two groups(P<0.05).This two parameters in the group of Wiltse paraspine approach are better than that oftraditional approach. But the postoperative ambulation time, hospital stays were no significantdifference between the two groups (P>0.05).There is no pedicle screw failure in two groups. Inthe following-up, there was no break off and knee bending of the fixation.Conclusion:Through the wiltse paraspinal approach can avoid stripping paraspinalmuscle, reduce the intraoperative blood loss and the paravertebral soft tissue injury, protectthe innervation of multifidi, decrease the paraspinal muscle degeneration caused by thesurgical trauma and can postoperative incidence of low back pain, improve the clinicalcurative effect. Provide the basis to the development of minimally invasive operation, so as toguide the clinical application of better.