Wiltse肌间隙入路在腰椎管减压内固定取出术中的临床疗效

Clinical efficacy in approach of Wiltse spatium intermusculare in the internal fixtion removal surgery by lumbar spinal canal decompression

目的研究Wiltse肌间隙入路与后正中入路在腰椎管减压内固定取出术的临床疗效。方法将该科2012年9月至2014年10月入院的74例腰椎管减压术后行内固定取出的患者按住院号奇偶数随机分为Wiltse肌间隙入路组(A组,37例)与后正中入路组(B组,37例)进行内固定取出术治疗,比较两组手术时间、术中出血量、术后引流量、术后3个月疼痛视觉模拟评分(VAS评分)及术后并发症发生率。结果 Wiltse肌间隙入路组患者手术时间(51.81±7.69)min、术中出血量(45.81±7.86)m L、术后引流量(34.30±6.91)m L及术后3个月VAS评分(1.05±0.78)分;后正中入路组的手术时间(68.41±14.63)min、术中出血量(67.14±7.72)m L、术后引流量(47.94±9.61)m L、术后3个月VAS评分(1.80±0.91)分,两组比较,差异均有统计学意义(P<0.05)。术后并发症发生率:Wiltse入路组为2.70%(1/37),正中入路组为16.21%(6/37),两组比较,差异有统计学意义(P<0.05)。结论 Wiltse入路与后正中入路相比,手术时间短、出血量少、术后腰背部疼痛较轻、并发症较少,可作为行腰椎管减压内固定取出术良好的选择。

Objective To approach the clinical effect of under Wiltse spatium intermusculare and postmiddle approaches in the internal fixtion removal surgery by lumbar spinal canal decompression. Methods A total of 74 patients with internal fixtion removal surgery by lumbar spinal canal decompression from September 2012 and October 2014 were enrolled and divided into the Wiltse spatium intermusculare group（37 cases） and the postmiddle group（37 cases） according to the even and odd numbers of hospitalization numbers,all of which were treated with internal fixtion. It was compared the operation time,bleeding volume during the operation,volume of drainage after the operation,VAS grading of the pain 3 months after the operation and the postoperative incidence difference of complications. Results There were statistically significant difference between the the Wiltse spatium intermusculare group and the postmiddle group in the operation time[（51.81±7.69） vs（68.41±14.63）min],bleeding volume during the operation[（45.81±7.86） vs（67.14±7.72）m L],volume of drainage after the operation[（34.30±6.91）vs（47.94±9.61）m L],VAS grading of the pain 3 months after the operation（1.05±0.78） vs（1.80±0.91）points（P〈0.05）. Conclusion Compared to the postmiddle approach,the Wiltse approach has a advantage of shorter operation time,less bleeding,lower pain at the waist and back after the surgery and less complications,which is a better choice in fixation removal by lumbar spinal canal decompression.