微创Wiltse入路与传统后正中入路手术在双节段腰椎管狭窄症中的应用比较

Comparison of applications between minimally invasive Wiltse approach and conventional posterior midline approach surgery in the treatment of double segment lumbar spinal stenosis

目的探讨双节段腰椎管狭窄症(LSS)患者应用微创椎旁肌间隙入路(Wiltse入路)与传统后正中入路手术治疗的临床效果。方法选取我院2014年1月~2015年10月收治且需行手术治疗的98例双节段LSS患者,随机均分为两组。对照组行传统后正中入路术式,观察组行微创Wiltse入路术式。记录并比较两组手术切口长度、出血量、术后引流量及手术时间等手术指标,并比较两组术前、术后3个月、术后半年腰椎Oswestry功能障碍指数(ODI)及腰、腿痛疼痛视觉模拟(VAS)评分。结果两组手术时间比较,无统计学差异(P>0.05);观察组手术切口长度、出血量及术后引流量依次为(4.72±1.23)cm、(153.45±23.66)ml、(95.86±12.75)ml,均显著低于对照组(P<0.01);两组术前腰椎ODI及腰、腿痛VAS评分比较,均无统计学差异(P>0.05);两组术后3个月、半年腰椎ODI及腰、腿痛VAS评分与术前比较,均显著改善(P<0.01);两组术后3个月、半年腿痛VAS评分比较,差异均无统计学意义(P>0.05);观察组术后3个月、半年腰椎ODI及腰痛VAS评分均明显小于对照组(P<0.05)。结论双节段LSS患者行微创Wiltse入路术式创伤小,有利于术后恢复及减少腰背痛的发生。

Objective To study the clinical effect of minimally invasive Wiltse approach and conventional posterior midline approach surgery in the treatment of double segment lumbar spinal stenosis (LSS). Methods 98 cases of double LSS patients treated in our hospital and in need of surgical treatment from Jan 2014 to Oct 2015 were selected and randomly divided into two groups. The operations of the control group were conducted with conventional posterior midline approach , while mini-mally invasive Wiltse approach was adopted in the observation group. Such surgery indexes as the length of incision , bleeding volume, postoperative lead flow and operation time were recorded and compared between the two groups. The lumbar Oswestry disability index (ODI) and visual simulation scores (VAS) of waist, leg pain of the two groups before operation, three months and half a year after operation were compared. Results There was no statistically significant difference as to the time of oper-ation (P>0.05). The length of operative incision, bleeding volume and postoperative lead flow of the observation group were (4.72±1.23)cm,(153.45±23.66)ml,(95.86±12.75)ml respectively,all of which were obviously lower than those of the control group (P<0.01). There was also no statistically significant difference as to the VAS scores of waist and leg pain and lumbar ODI of two groups before the operation (P>0.05);3 months and half a year after operation,the VAS scores of waist and leg pain and lumbar ODI of the two groups all improved greatly compared with those before operation (P<0.01); there were no statistically significant differences as to the comparison of VAS scores of leg pain of the two groups after 3 months and half a year of the op-eration (P>0.05); the lumar ODI and VAS scores of waist pain of the observation group after 3 months and half a year were all lower than those of the control group (P<0.05). Conclusion The minimally invasive Wiltse approach operation on double segment LSS patients has little trauma, it is helpful to promote postoperative recovery and reduce waist and back pain.