经Wiltse入路与后正中入路治疗腰椎椎间盘突出症的疗效比较

目的比较Wiltse入路与后正中入路治疗腰椎椎间盘突出症(LDH)的疗效。方法收集2012年1月—2015年12月在本院行手术治疗的LDH患者85例,其中经Wiltse入路43例(A组),传统后正中入路42例(B组)。记录2组患者的手术时间、术中出血量、术后引流量及住院天数等资料;采用视觉模拟量表(VAS)评分评价患者腰痛和下肢痛,采用Oswestry功能障碍指数(ODI)评价患者功能状况,采用日本骨科学会(JOA)评分评价患者腰椎功能。结果 A组患者在术中出血量、术后引流量、住院天数、术后腰痛VAS评分方面优于B组,差异有统计学意义(P0.05);2组手术时间、术后下肢痛VAS评分、ODI及JOA评分差异无统计学意义(P0.05)。术后随访6个月、2年,A组腰痛VAS评分优于B组,差异有统计学意义(P0.05)。结论采用Wiltse入路治疗LDH在降低手术创伤、减少住院天数、减少术后腰痛、减少残留神经功能后遗症等方面均优于传统后正中入路,临床值得推广。

Wiltse approach versus posterior midline approach surgery for lumbar disc herniation

Objective To compare the clinical outcomes of the Wiltse approach versus posterior midline approach for the treatment of lumbar disc herniation. Methods From January 2012 to December 2015,85 patients with lumbar disc herniation were enrolled according to inclusion and exclusion criteria. The patients were randomly divided into 2 groups according to operative approach,Wiltse approach as group A(n=43) and posterior midline approach as group B(n=42). The hospital stay,operative time,blood loss and postoperative drainage were recorded. The low back pain and leg pain of the patients were evaluated by visual analogue scale(VAS),the disability status was evaluated by Oswestry disability index(ODI),and the low back disability improvement rate was calculated by Japanese Orthopaedics Association(JOA) score. Results Group A was superior to the group B in length of stay,blood loss,postoperative drainage,and postoperative low back pain VAS score,and the difference was statistically significant(P < 0.05). There were no statistical differences in operation time,postoperative leg pain VAS score,ODI and JOA score(P > 0.05). Group A were superior to group B in low back pain VAS scores at 6-month and 2-year follow-up,with statistical significance(P < 0.05). Conclusion Wiltse approach is superior to conventional approach in minimally invasion,reducing hospital stay,reducing postoperative lower back pain and reducing the disability,thus being worth spreading in clinical use.