Wiltse入路与后正中入路腰椎椎间融合术治疗退变性腰椎间盘疾病的疗效比较

Comparative Study of Lumbar Interbody Fusion between Wiltse Approach and Traditional Posterior Approach in the Treatment of Lumbar Degenerative Diseases

目的比较Wiltse入路与后正中入路腰椎椎间融合术治疗单节段退变性腰椎间盘疾病的疗效。方法将手术适应症明确的42例单节段退变性腰椎间盘疾病连续病例随机分为两组,其中Wiltse入路组22例在自行设计拉钩辅助下,行经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF),后正中入路组20例行后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF),记录两组患者的手术时间、术中出血量、术后住院时间;采用疼痛视觉模拟评分(visual analogue scal,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)评估两组患者手术后的临床疗效;采用suk法评价两组患者术后椎间融合情况。结果全部病例平均随访14个月。Wiltse入路组术中出血量为(130.5±16.5)mL、术后住院时间为(7±1.5)d,后正中入路组分别为(390.8±24.8)mL、(13±2.5)d,Wiltse入路组明显优于后正中入路组(P<0.05),两组患者术后腰痛、腿痛VAS评分和ODI均较术前明显降低,术后3个月及末次随访Wiltse入路组腰痛VAS评分和ODI均低于后正中入路组(P<0.05),腿痛VAS评分、椎间融合率、手术时间两组比较差异无统计学意义(P>0.05)。结论经Wiltse入路与后正中入路治疗退变性腰椎间盘疾病均能达到满意的疗效,但Wiltse入路手术出血少,术后住院时间短,术后腰背痛残留率低,更好的解决了退变性腰椎间盘疾病患者的病痛。

Objective To compare the clinical results of lumbar interbody fusion between Wiltse approach and traditional posterior approach in the treatment of one- level lumbar degenerative diseases. Methods 42 consecutive cases with single segmental lumbar degenerative disease underwent surgery intervention were prospective analyzed. Among them,22 cases received minimally invasive operation( transforaminal lumbar interbody fusion,TLIF) with self- made hook; 20 cases received open surgery( posterior lumbar interbody fusion, PLIF). Operation time,intraoperative bleeding and postoperative ambulation time were recorded. VAS scale system and ODI were used to evaluate the low back pain and leg pain preoperatively and postoperatively respectively. The lumbar interbody fusion was assessed by the suk’s method. Results Average follow- up was 14 months. Intraoperative bleeding,postoperative ambulation time,the minimally group was less than traditional group( P &lt; 0. 05). Compared to preoperation,both the VAS of back leg pain and ODI in two groups improved significantly postoperatively. However,minimally group showed less back pain and ODI during the 3- month and the last follow up postoperatively( P &lt; 0. 05),while there have no significant differences of VAS of leg pain,lumbar interbody fusion and operation time between minimally group and traditional group. Conclusion Mini- open TLIF by wiltse approach as well as open surgery PLIF can get satisfactory clinical outcome. Mini- open TLIF by wiltse approach has advantages as follows: less invasive,less intraoperative bleeding, earlier postoperative ambulation time,lower incidence of back pain in the duration of follow- up.