经Wiltse入路行腰椎翻修手术的临床疗效观察

Clinical efficacy of lumbar revision surgery via the Wiltse approach

目的探讨经Wiltse入路行腰椎翻修手术的临床疗效。方法回顾性分析2012年1月至2018年8月于我院行腰椎翻修手术病人59例,按手术入路方式分为两组,其中Wiltse入路组31例,传统入路组28例。收集并比较两组病人的手术时间、术后住院时间、术中出血量、引流量、术后并发症情况、疼痛视觉模拟量表(visual analog scale, VAS)评分、健康调查简表(the MOS 36-item short-form health survey, SF-36)评分、Oswestry功能障碍指数(Oswestry disability index, ODI)。结果所有病人均顺利完成手术。随访时间为12~40个月,平均25.5个月。Wiltse入路组病人的手术时间、术中出血量、术后引流量、术后住院时间分别为(3.51±0.36)h、(372.58±90.81)ml、(226.07±116.73)ml、(7.68±1.83)d;传统入路组分别为(4.20±0.82)h、(392.50±142.38)ml、(296.92±106.01)ml、(8.29±2.17)d;Wiltse入路组的手术时间和术后引流量均明显小于传统入路组,差异均有统计学意义(P均<0.05)。59例病人术后1个月、1年随访时的腰椎VAS评分、ODI、SF-36评分均较术前显著改善;两组间比较,Wiltse入路组术后1个月的VAS评分和ODI显著优于传统入路组;上述指标比较,差异均有统计学意义(P均<0.05),其他指标的差异均无统计学意义(P均>0.05)。两组病人均未出现严重并发症。结论与传统入路相比,Wiltse入路行腰椎翻修手术具有手术时间短、术后引流量少、软组织损伤小、腰部功能恢复快等优点,临床疗效满意。

Objective To investigate the clinical efficacy of revision surgery via the Wiltse approach.Methods A retrospective analysis was performed on 59 patients undergoing lumbar revision who were admitted to our hospital from January 2012 to August 2018.All patients were divided into two groups according to the surgical approach,including 31 cases in the Wiltse approach group and 28 cases in the traditional approach group.The operation time,postoperative hospital stay,intraoperative blood loss,drainage volume,postoperative complications,visual analog scale(VAS) score,MOS 36-item short-form health survey(SF-36),and Oswestry disability index(ODI) between two groups were compared.Results All patients successfully completed the operation.The follow-up time was 12-40 months,with an average of 25.5 months.The operation time,intraoperative bleeding volume,postoperative drainage volume and postoperative hospital stay in Wiltse approach group were(3.51±0.36) h,(372.58±90.81) ml,(226.07±116.73) ml,(7.68±1.83) days,respectively,and those in traditional approach group were(4.20±0.82) h,(392.50±142.38) ml,(296.92±106.01) ml and(8.29±2.17) days,respectively.The operation time was significantly shorter and postoperative drainage volume was significantly less in Wiltse approach group than those in traditional approach group(P<0.05).The VAS score,ODI and SF-36 score of lumbar vertebrae in 59 patients were significantly improved 1 month after operation and at 1 st year following follow-up.The VAS score and ODI at 1 st month after operation in Wiltse approach group were significantly better than those in traditional appraoch group(P<0.05),and there was no significant difference in the rest indicators(P>0.05).There were no serious complications in both groups.Conclusion Compared with the traditional approach,the Wiltse approach for lumbar revision surgery has the advantages of shorter operation time,less wound drainage,milder soft tissue damage and quicker recovery of lumbar function after surgery,and the clinical effectiveness is satisfactory.