Wiltse入路和后正中入路治疗腰椎退行性疾病的疗效对比研究’

目的探讨不同手术入路在治疗腰椎退行性疾病中的优缺点及其对临床疗效的影响。方法自2011年3月至2011年9月，采用腰椎后路椎管减压椎间植骨融合内固定术治疗40例腰椎退行性疾病患者，男24例，女16例。年龄42．0～73．0岁，平均（55．3±6．1）岁。病程（26．5±4．5）个月。按人院顺序随机分为Wihse入路组和后正中入路组，每组各20例，分别观察两组患者手术总时间、手术野显露时间、术中出血量、术后引流量、切VI并发症、手术前后Oswestry功能障碍指数（ODI）、视觉模拟评分法（VAS）等指标，比较两种入路对手术及临床疗效的影响。结果40例患者均获随访，平均随访12．7个月；Wihse入路组和后正中入路组手术总时间、术中出血量无显著差异（P〉0．05）；Wihse入路组手术野显露时间、术后切口引流量显著低于后正中入路手术组（P〈0．05）；术后ODI评分、VAS评分显著优于后正中入路组（P〈0．05）；两组患者术后均未出现伤口相关并发症。结论与后正中入路比较，Wiltse入路具有术野显露迅速、软组织损伤小、术后腰部功能康复好等优点，有助于提高临床疗效。

Comparison of the clinical effects of Wiltse approach vs. posterior midline approach in the treatment of lumbar degenerative disc disease

Objective To compare the clinical effects of Wiltse approach vs. posterior midline approach in the treatment of lumbar degenerative disc diseases. Methods From March to September in 2011, 40 patients, 24 males and 16 females with an average age of 55.3 -＋ 6. 1 years old （range： 42. 0 to 73.0）, with lumbar degenerative disc disease who had indications to ac- cept spine surgery （transforaminal lumbar interbody fusion, TLIF） were divided into two groups randomly and equally： Wihse approach group and posterior midline approach group. Mean operation time, surgical field exposing time, volume of blood loss, postoperative drainage volume and complications of wound were compared between two groups. The clinical effects of the two groups were compared by using Oswestry Disability Index （ODD, Visual Analogue Scale （VAS） score pre~operation and post- operation, respectively. Results All patients were followed-up for average 12. 7 months. There was no significant difference in mean operation time, volume of blood loss, and complication of wound between Wiltse approach group and posterior midline approach group （P~0. 05）. The average time of surgical field exposure and postoperative drainage volume in Wiltse approach group were significant decreased as compared with those in posterior midline approach group （P~0. {）5）. The postoperative scores of ODI and VAS score in Wiltse approach group were superior to those of posterior midline approach group significantly （P%0. {）5）. There were no complications associated with wound in both two groups. Conclusion As compared with the tradi tional posterior midline approach, Wihse approach could shorten the time for surgical field exposure, minimize the invasion to the paraspinal muscle and gain better clinicaI effects.