Wiltse入路与后正中入路经椎间孔椎体间融合的比较

Transforaminal lumbar interbody fusion through Wiltse approach versus traditional posterior midline approach

[目的]探讨Wiltse入路与后正中入路经椎间孔腰椎融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎管狭窄症的临床疗效。[方法]回顾分析2021年11月—2022年9月本院收治的40腰椎管狭窄症患者的临床资料,根据医患沟通结果,19例采用W-TLIF,21例采用传统后正中入路TLIF,比较两组临床及多裂肌检查资料。[结果]两组均顺利完成手术,两组手术时间、切口总长度、术中出血量、术后引流量、术中透视次数的差异均无统计学意义(P>0.05)。W-TLIF组地行走时间显著早于后正中TLIF组[(2.3±0.8)d vs(4.0±1.1)d,P<0.05]。随访时间平均(7.1±0.9)个月,随时间推移,两组VAS及ODI评分均显著减少(P<0.05)。术后6个月W-TLIF组VAS[(1.0±0.5)vs(2.0±1.0),P=0.013]及ODI评分[(11.6±1.8)vs(16.0±3.7),P<0.001]均显著优于TLIF组(P<0.05)。多裂肌检测方面,与术前相比,两组术后1、3、6个月LMCSA、MUAP均显著减小(P<0.05),DPR无显著变化(P>0.05)。术前两组LMCSA、MUAP的差异均无统计学意义(P>0.05);术后6个月W-TLIF组LMCSA[(510.8±54.9)mm2vs(280.7±32.2)mm2,P<0.05]和MUAP[(504.4±58.1)μV vs(313.7±71.0)μV,P<0.05]均显著大于TLIF组。术后相应时间点W-TLIF组多裂肌失神经电位出现率均显著低于TLIF组(P<0.05)。[结论]W-TLIF组对多裂肌损伤低于后正中TLIF组,可减轻疼痛,有利于早期康复。

[Objective]To evaluate the clinical efficacy of Wiltse approach transforaminal lumbar interbody fusion(W-TLIF),by com⁃parison with the traditional posterior midline approach transforaminal lumbar interbody fusion(TLIF)in the treatment of lumbar spinal ste⁃nosis.[Methods]A retrospective study was conducted on 40 patients who received TLIFs for lumbar spinal stenosis in our hospital from No⁃vember 2021 to September 2022.According to doctor-patient communication,19 patients were treated with W-TLIF,while other 21 pa⁃tients were treated with traditional TLIF.The clinical and multifidus examination data of the two groups were compared.[Results]All pa⁃tients in both groups had corresponding surgical procedures performed successfully without significant differences in operation time,total incision length,intraoperative blood loss,postoperative drainage volume,and intraoperative fluoroscopy times between the two groups(P>0.05),while the patients in the W-TLIF group resumed postoperative ambulation significantly earlier than those in the TLIF group[(2.3±0.8)days vs(4.0±1.1)days,P<0.05].With time of the follow-up period lasted for(7.1±0.9)months on a mean,the VAS and ODI scores were significantly decreased in both groups(P<0.05).The W-TLIF group were significantly better than the TLIF group 6 months after oper⁃ation in terms of VAS score[(1.0±0.5)vs(2.0±1.0),P=0.013]and ODI socre[(11.6±1.8)vs(16.0±3.7),P<0.001].Regarding multifidus de⁃tection,the lean mutifidus cross sectional area(LMCSA)and motor unit action potential(MUAP)were significantly decreased in both groups 1,3 and 6 months after operation compared with those before operation(P<0.05),while the denervated potential ratio(DPR)re⁃mained unchanged(P>0.05).Although there were no significant differences in LMCSA and MUAP between the two groups before surgery(P>0.05),the W-TLIF group was significantly superior to the TLIF group in terms of LMCSA[(510.8±54.9)mm2 vs(280.7±32.2)mm2,P<0.05]and MUAP[(504.4±58.1)μV vs(313.7±71.0)μV,P<0.05]6 months postoperatively,additionally,the former was also significantly better than the latter in term of DPR at all time points postoperatively accordingly(P<0.05).[Conclusion]The Wiltse approach TLIF has lower damage to the multifidus muscle than the traditional posterior midline approach TLIF,which does reduce pain and is conducive to early rehabilitation.