Street John T, Andrew Glennie R, Dea Nicolas, DiPaola Christian, Wang Zhi, Boyd Michael, Paquette Scott J, Kwon Brian K, Dvorak Marcel F, Fisher Charles G
Vancouver Spine Surgery Institute and Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia;
Division of Orthopedics, Dalhousie University, Halifax, Nova Scotia;
J Neurosurg Spine. 2016 Sep;25(3):332-8. doi: 10.3171/2016.2.SPINE151018. Epub 2016 Apr 22.
OBJECTIVE The objective of this study was to determine if there is a significant difference in surgical site infection (SSI) when comparing the Wiltse and midline approaches for posterior instrumented interbody fusions of the lumbar spine and, secondarily, to evaluate if the reoperation rates and specific causes for reoperation were similar for both approaches. METHODS A total of 358 patients who underwent 1- or 2-level posterior instrumented interbody fusions for degenerative lumbar spinal pathology through either a midline or Wiltse approach were prospectively followed between March 2005 and January 2011 at a single tertiary care facility. A retrospective analysis was performed primarily to evaluate the incidence of SSI and the incidence and causes for reoperation. Secondary outcome measures included intraoperative complications, blood loss, and length of stay. A matched analysis was performed using the Fisher's exact test and a logistic regression model. The matched analysis controlled for age, sex, comorbidities, number of index levels addressed surgically, number of levels fused, and the use of bone grafting. RESULTS All patients returned for follow-up at 1 year, and adverse events were followed for 2 years. The rate of SSI was greater in the midline group (8 of 103 patients; 7.8%) versus the Wiltse group (1 of 103 patients; 1.0%) (p = 0.018). Fewer additional surgical procedures were performed in the Wiltse group (p = 0.025; OR 0.47; 95% CI 0.23-0.95). Proximal adjacent segment failure requiring reoperation occurred more frequently in the midline group (15 of 103 patients; 14.6%) versus the Wiltse group (6 of 103 patients; 5.8%) (p = 0.048). Blood loss was significantly lower in the Wiltse group (436 ml) versus the midline group (703 ml); however, there was no significant difference between the 2 groups in intraoperative complications or length of stay. CONCLUSIONS The patients who underwent the Wiltse approach had a decreased risk of wound breakdown and infection, less blood loss, and fewer reoperations than the midline patients. The risk of adjacent segment failure in short posterior constructs is lower with a Wiltse approach.
目的 本研究的目的是确定在比较腰椎后路器械辅助椎间融合术的Wiltse入路和中线入路时手术部位感染（SSI）是否存在显著差异，其次，评估两种入路的再次手术率和再次手术的具体原因是否相似。方法 2005年3月至2011年1月期间，在一家三级医疗中心对358例因退行性腰椎疾病接受1或2节段后路器械辅助椎间融合术的患者进行了前瞻性随访，这些患者通过中线或Wiltse入路进行手术。主要进行回顾性分析以评估SSI的发生率以及再次手术的发生率和原因。次要结局指标包括术中并发症、失血量和住院时间。使用Fisher精确检验和逻辑回归模型进行匹配分析。匹配分析控制了年龄、性别、合并症、手术治疗的索引节段数量、融合节段数量以及骨移植的使用情况。结果 所有患者均在1年时返回进行随访，不良事件随访2年。中线组的SSI发生率（103例患者中的8例；7.8%）高于Wiltse组（103例患者中的1例；1.0%）（p = 0.018）。Wiltse组进行的额外手术较少（p = 0.025；OR 0.47；95% CI 0.23 - 0.95）。中线组因近端相邻节段失败需要再次手术的发生率（103例患者中的15例；14.6%）高于Wiltse组（103例患者中的6例；5.8%）（p = 0.048）。Wiltse组的失血量（436 ml）明显低于中线组（703 ml）；然而，两组在术中并发症或住院时间方面没有显著差异。结论 与中线入路的患者相比，采用Wiltse入路的患者伤口裂开和感染风险降低，失血量减少，再次手术次数减少。采用Wiltse入路时，短节段后路结构中相邻节段失败的风险较低。
