Clinical efficacy of percutaneous minimally invasive,Wiltse minimally invasive approach and traditional posterior approach for the treatment of thoracolumbar fracture in senile patients

LI Jia; ZHU Jia-xing; WANG Lei; CHE Xiao-ming; ZHANG Xin; SHAN Zhong-shu; LIU Wei

doi:10.13820/j.cnki.gdyx.20231711

Abstract：Objective To evaluate the clinical efficacy of percutaneous,Wiltse's approach minimally invasive,and traditional open approaches combined with pedicle fixation of injured vertebrae for treating thoracolumbar fractures in old patients.Methods A retrospective analysis was conducted on 98 elderly patients diagnosed with thoracolumbar ver-tebral fractures from March 2018 to December 2021.Patients were categorized into three groups based on the surgical ap-proach:percutaneous group[31 cases,14 males,17 females,average age(69.3±6.6)years],Wiltse group[33 ca-ses,12 males,21 females,average age(68.7±7.1)years],and open group[34 cases,16 males,18 females,average age(67.7±6.9)years].Surgical time,intraoperative blood loss,postoperative drainage volume,fluoroscopy frequency,hospital stay,Cobb's angle,anterior vertebral height of the injured vertebrae,Visual Analog Scale(VAS)score,Oswe-stry Disability Index(ODI),and related complications were compared among the three groups.Results In all three groups,the anterior vertebral height of the injured vertebrae and Cobb's angle were significantly improved postoperatively(P＜0.05),with no significant differences among the three groups postoperatively(P＞0.05).During the perioperative period,the percutaneous group had significantly longer surgical time and more frequent fluoroscopy compared to the other two groups,with statistical significance(P＜0.05).The open group had significantly greater intraoperative blood loss and longer hospital stays compared to the other two groups,with statistical significance(P＜0.05).Postoperative drainage volumes differed significantly among the three groups(P＜0.05).Postoperative VAS scores and ODI values decreased compared to preoperative values in all three groups(P＜0.05),and patients in the percutaneous and Wiltse groups had better postoperative VAS scores and ODI values than those in the open group(P＜0.05).The open group experienced more surgical and comorbidity-related complications postoperatively,with statistical significance compared to the other two groups(P＜0.05).Conclusion All three methods are effective for treating thoracolumbar vertebral fractures in eld-erly patients.However,the percutaneous and Wiltse minimally invasive approaches have advantages in preserving soft tis-sue and promoting postoperative functional recovery compared to the traditional open approach.The choice of treatment method should be based on the specific circumstances of the patient to achieve better clinical outcomes.