| [Objective]To observe the changes of the cross sectional area(CSA)of paravertebral muscles,Visual Analog Scale(VAS)and Oswestry Dability Index(ODI)in patients with thoracolumbar fracture treated by two procedures that include Wiltse approach and Posterior median approach before surgery and after surgery;To explore the influence on paravertebral muscles via the two approaches to treat thoracolumbar fracture.[Method]A total of 57 patients with thoracolumbar fractures admitted to the Department of Spine Surgery,the First Affiliated Hospital of Dali University during the period from January 2019 to December 2021 were retrospectively analyzed.They were divided into two groups.One group was Wiltse approach that operated with Wiltse paraspinal approach and pedicle screw fixation(n=21),another group was posterior median approach which operated with conventional approach and pedicle screw fixation(n=36).General data such as gender,age,and fracture segment of the two groups were collected.The CSA of psoas major,erector spinae,longissimus and multifidus were measured by computed tomography before operation and at 3,6,9 and 12 months after operation in the two groups.The VAS scores and ODI scores were collected before operation and at 3,6,9 and 12 months after operation between the two groups.We used SPSS25.0 software to analyse data of this study.The measured data were expressed as(x ± s)and t-test was used.We used Chi square test to analyse the count data.All graphs were drawn using GraphPad Prism 9.4 software.Ap value of less than 0.05 was considered statistically significant.[Results]1.Comparison of general informationThere was no significant difference in gender,age and fracture segment between the two groups(P>0.05).2.The CS A of all kinds of the paraspinal muscles were compared between the two groups before operation and at each time after operation(unit:cm2).2.1 Comparison of the CSA of psoas majorWiltse approach group vs Posterior median approach group:before operation was 4.249±3.076 vs 4.786±3.656,respectively(P=0.667),the difference was not statisticallysignificant;At 3 months after operation was 4.157±3.039 vs 4.523±3.306,the difference was not statistically significant(P=0.620);At 6 months after operation was 4.035±3.040 vs 4.249±2.904,the difference was not statistically significant(P=0.530);At 9 months after operation was 3.933±3.040 vs 3.933±2.583,the difference was not statistically significant(P=0.691);At 12 months after operation was 3.820±3.040 vs 3.548±2.154,respectively(P=0.655),the difference was not statistically significant.2.2 Comparison of the CSA of erector spinaeWiltse approach group vs Posterior median approach group:before operation was 20.977±8.393 vs 22.302±9.462,respectively(P=0.597),the difference was not statistically significant;At 3 months after operation was 17.639±7.170 vs 17.359±8.484,the difference was not statistically significant(P=0.830);At 6 months after operation was 14.636±6.032 vs 14.553±6.878,the difference was not statistically significant(P=0.772);At 9 months after operation was 11.952±4.584 vs 12.225±6.028,the difference was not statistically significant(P=0.817);At 12 months after operation was 10.089±4.063 vs 7.020±3.359,respectively(P=0.006),the difference was statistically significant.2.3 Comparison of the CSA of longissimusWiltse approach group vs Posterior median approach group:before operation was 5.490±1.716 vs 5.202±2.224,respectively(P=0.305),the difference was not statistically significant;At 3 months after operation was 4.926±1.542 vs 4.643±2.042,the difference was not statistically significant(P=0.279);At 6 months after operation was 4.415±1.582 vs 4.064±1.892,the difference was not statistically significant(P=0.250);At 9 months after operation was 3.902±1.548 vs 3.296±1.479,the difference was not statistically significant(P=0.128);At 12 months after operation was 3.485±1.479 vs 2.522±1.077,respectively(P=0.005),the difference was statistically significant.2.4 Comparison of the CSA of multifidusWiltse approach group vs Posterior median approach group:before operation was 4.275±1.708 vs 4.391±2.867,respectively(P=0.779),the difference was not statistically significant;At 3 months after operation was 3.907±1.667 vs 3.844±1.895,the difference was not statistically significant(P=0.585);At 6 months after operation was 3.505±1.618 vs 3.310±1.660,the difference was not statistically significant(P=0.321);At 9 months after operation was 3.065±1.390 vs 2.691 ±1.343,the difference was not statistically significant(P=0.168);At 12 months after operation was 2.767±1.205 vs 1.437±0.780,respectively(P=0.000),the difference was statistically significant.3.Comparison of VAS scoresWiltse approach group vs Posterior median approach group:before operation was 7.620±0.498 vs 7.470±0.506,respectively(P=0.293),the difference was not statistically significant;At 3 months after operation was 6.100±0.436 vs 6.560±0.504,the difference was statistically significant(P=0.001);At 6 months after operation was 4.520±0.512 vs 5.530±0.506,the difference was statistically significant(P=0.000);At 9 months after operation was 4.480±0.512 vs 4.250±0.439,the difference was not statistically significant(P=0.099);At 12 months after operation was 3.480±0.512 vs 3.470±0.506,respectively(P=0.977),the difference was not statistically significant.4.Comparison of ODI scoresWiltse approach group VS Posterior median approach group:before operation was 42.480±0.602 vs 42.250±0.692,respectively(P=0.218),the difference was not statistically significant;At 3 months after operation was 31.140±0.727 vs 33.310±0.668,the difference was statistically significant(P=0.000);At 6 months after operation was 20.810±0.680 vs 23.500±0.507,the difference was statistically significant(P=0.000);At 9 months after operation was 13.570±0.507 vs 13.560±0.558,the difference was not statistically significant(P=0.915);At 12 months after operation was 5.520±0.512 vs 5.420±0.500,respectively(P=0.442),the difference was not statistically significant.[Conclusion]1.At 3,6,9,12 months after the operation of thoracolumbar fractures with Wiltse approach or Posterior median approach,the paraspinal muscles showed different degrees of atrophy.2.More than Posterior median approach,Wiltse approach can significantly reduce the injury to the paraspinal muscles after operation.3.At short-term post-operation,that was to say at 3,6 months after operation,more than Posterior median approach,Wiltse approach can reduce thoracolumbar back pain,thoracolumbar back had better improvement in function;However,the two operative approaches had no significant difference in the long term,namely,at 9,12 months after operation. |
PDF Full Text Request