Wiltse入路腰椎动态固定系统治疗腰椎间盘突出症的早期疗效

Early Efficacy of Dynamic Stabilization System Through Wiltse Approach on Lumbar Disc Herniation

目的:观察经Wiltse入路(多裂肌与最长肌间隙入路)腰椎动态固定治疗腰椎间盘突出症的疗效,并与传统后方入路的疗效进行比较。方法:本研究共纳入46例患者,均因腰椎间盘突出症于2011年1月到2013年1月分别在我院行腰椎间盘摘除+腰椎动态稳定系统固定术,其中经传统后方入路25例,Wiltse入路21例;男26人,女20人,年龄24-60岁,平均45.5岁。对手术切口、手术时间、术中失血量、术后引流量、术后1周、6个月腰腿痛VAS评分进行比较。定期行X线片检查观察内固定情况。结果:46例患者均获得随访,随访时间7-31个月,平均(13.8±2.4)个月。传统后方入路组与Wiltse入路组的平均手术切口长度分别为(7.5±0.7)cm和(4.5±0.5)cm,手术时间分别为(150.8±52.7)min和(126.3±43.9)min,术中失血量分别为(420.4±109.7)ml和(227.1±96.4)ml,术后引流量分别为(316.8±56.3)ml和(112.5±47.6)ml,术后1周腰腿痛VAS评分分别为2.5±1.2和2.3±0.7,术后6个月腰腿痛VAS评分分别为1.2±0.4和1.1±0.3。两组患者相比,切口长度、术中失血量和术后引流量的差异具有统计学意义,而术后1周和6个月的腰腿痛VAS评分以及手术时间的差异无统计学意义。末次随访时X线片示所有患者内固定物位置良好,无松动或断裂。结论:Wiltse入路腰椎动态固定系统治疗腰椎间盘突出症的早期疗效满意,与传统后方入路相比,具有手术切口小,术中失血量少和并发症少等优点。

Objective： To compare the effect of dynamic stabilization system through Wiltse approach and traditional posterior approach for lumbar disc herniation. Methods： A total of 46 patients, who had undergone discectomy and internal fixation using dynamic stabilization systems for lum- bar disc herniation from January 2011 to January 2013, were enrolled in this study. The operation was performed through the traditional posterior approach in 25 patients and Wiltse approach in 21 patients. There were 26 males and 20 females, aged from 24 to 60 years （average, 45.5 years）. The length of incision, operative time, blood loss, postoperative drainage amount, pre- and post- operative VAS and complications were recorded and compared between two groups. The X-ray was used to evaluate the condition of internal fixation. Results. All patients were followed up for 7 to 31 months （average, [13.8±2.4] months）. The length of incision, operative time, bloodloss, postoperative drainage amount were （7.5±0.7） cm vs （4.5±0.5） cm, （150.8±52.7） min vs （126.3±43.9） min, （420.4±109.7） ml vs （227. 1±96.4） ml, and （316.8±56.3） ml vs （112.5±47.6） ml in traditional posterior approach group and Wiltse approach group, respective- ly. The average VAS was （2.5±1.2） vs （2.3±0.7） at 1 week postoperatively in traditional pos- terior approach group and Wiltse approach group, respectively, and （1.2~0.4） vs （1.1~0.3） at 6 months postoperatively. There were statistical differences in length of incision, blood loss, and postoperative drainage amount between the two groups, while no significant difference was found in VAS and operative time. X-rays at final follow-up showed the position of fixators was good, without lossening or breakage. Conclusion： The early effect of dynamic stabilization system through Wihse approach for lumbar disc herniation is satisfactory, and compared with the tradi- tional posterior approach, it has the advantages of shorter incision, less blood loss, and less com- plications.