Abstract: Objective To compare the clinical efficacy of percutaneous and wiltse approach for the internal fixation of single-segment thoracolumbar AO Type A3 fractures. Methods A retrospective analysis was conducted on 74 patients with single-segment thoracolumbar Type A3 fractures treated at Jieyang People's Hospital from January 1, 2021, to December 31, 2022. The patients were divided into two groups based on different surgical methods： percutaneous screw fixation group（n=38） and transmuscular approach group（wiltse group, n=36）. The clinical outcomes and radiological indicators of the two groups were compared. Results All cases were followed up for one year. There were no significant statistical differences in intraoperative blood loss, incision length, postoperative hospital stay, and hospitalization costs between the two groups. The surgical time for the percutaneous screw group was 121.6±19.4 min, while for the intermuscular interval group it was 91.7±19.3 min （P<0.05）. The number of intraoperative radiation exposures for the percutaneous screw group（15.0±2.1） was higher than for the intermuscular interval group （5.1±1.1） （P<0.05）. Both groups effectively improved vertebral angle, vertebral height, and clinical scores such as VAS, ODI after surgery. The wiltse group showed better results in vertebral angle and Cobb's angle （P<0.05）. One case of poor incision healing occurred in the percutaneous screw group, and there were no serious complications in either group. Conclusion Both percutaneous and wiltse approach for pedicle screw internal fixation are effective in treating single-segment thoracolumbar AO Type A3 fractures. The wiltse group had fewer intraoperative radiation exposures, shorter surgical time, and better postoperative vertebral height recovery, making it more suitablefor use in primary hospitals.

Key words: thoracolumbar fractures, percutaneous pedicle screw, wiltse approach, AO type A3 fractures

摘要： 目的 对比经皮与肌间隙入路椎弓根螺钉内固定治疗单节段胸腰段AO分型A3型骨折患者的临床疗效。方法 回顾分析揭阳市人民医院2021年1月1日至2022年12月31日期间收治的74例单节段胸腰段A3型骨折患者,根据手术方法不同分为经皮螺钉内固定组（38例）和经肌间隙入路（wiltse入路）（经肌间隙组,36例）比较两组的临床疗效和影像学指标。结果 所有病例随访1年。两组术中失血量、切口长度、术后住院时间、住院费用无统计学差异。经皮螺钉组手术时间为121.6±19.4 min,而肌间隙组为91.7±19.3min（P<0.05）。经皮螺钉组术中放射次数（15.0±2.1）较经肌间隙组（5.1±1.1）多（P<0.05）。两组术后均能有效改善椎体角、椎体高度及VAS、ODI等临床评分。其中经肌间隙组在椎体夹角、cobb角更优（P<0.05）。经皮螺钉组发生一例切口愈合不良,两组均无严重并发症发生。结论 经皮与椎弓根入路椎弓根螺钉内固定技术均可有效治疗单节段胸腰段AO A3型骨折,经肌间隙组术中放射次数少,手术时间短,术后椎体高度恢复更优,更适合在基层医院开展使用。

关键词: 胸腰段骨折, 经皮椎弓根螺钉内固定, 经肌间隙入路椎弓根螺钉内固定, AO A3型骨折