经肌间隙与传统入路行腰椎融合固定术的对比研究

Comparison between Wiltse approach and conventional approach for lumbar instrumentation and fusion

目的比较肌间隙与传统入路对腰椎内固定术中腰背肌损伤及术后病人短期恢复情况的影响。方法采用随机对照临床试验设计,将病人分为肌间隙入路组(A组)和传统入路组(B组)。按照随机数字表进行随机分组。测量基线肌酸激酶(CK)、谷草转氨酶(AST)、VAS和ODI评分。记录手术时间、术中出血量,术后第1和第3天的CK、AST,术后48 h内引流量、术后3 d经B超测定的伤口积液量,术后5 d、3个月的VAS和ODI评分。结果共纳入57例病人,其中A组27例,B组30例。两组的年龄、基线CK、AST、VAS和ODI评分无显著差异(P>0.05)。两组的手术时间、术中出血量无显著差异。术后48小时融合侧的引流量无显著差异,但融合对侧有显著差异(P<0.05)。术后第1天的CK、AST有显著差异(P<0.05),而第3天无显著差异。术后第5天和3个月的VAS和ODI评分有显著差异(P<0.05)。结论经肌间隙入路能减轻手术对多裂肌的损伤,有利于病人术后恢复。

Objective To compare the influence of Wiltse approach and conventional approach on short-term postoperational recovery and muscle injury for patients received lumbar instrumentation and fusion. Method This is a Random Control Trial. Patients were randomized into bilateral Wiltse approach group （Group A） or bilateral conventional approach group （Group B）. Decompression and fusion was performed unilaterally. Baseline Creatine kinase （CK）, Aspartate aminotransferase （AST）, Visual Analog Scale （VAS）, Oswetry Disability Index （ODI） were measured. Drainage was placed on both side, and removed 48 hours after surgery. Operation duration and blood loss were recorded. CK and AST on postoperational Day 1 and Day 3, bilateral drainage volume within 48 hours after surgery, wound fluid volume measured by Ultrasonogram on postoperational Day 3, VAS and ODI on postoperational Day 5 and 3-month were recorded. Result There were 57 patients in total, with 27 patients in Group A and 30 patients in Group B. There were no significant difference between the two groups in age, baseline CK, AST, VAS and ODI （P〉0.05）. Operation duration and blood loss were similar. There was no significant difference in drainage volume on fusion side within 48 hours after operation, but significant difference in contralateral drainage volume （P〈0.05）. There was significant difference in CK and AST on postoperational Day 1 but not on Day 3. There were significant differences in VAS and ODI between two groups on postoperational Day 5 and 3-month. Conclusion It is plausible to complete lumbar instrumentation and intervertebral fusion through Wiltse approach. Wiltse approach could reduce muscle injury during operation, which is favorable for short-term recovery of patients.