Cheng Wei-Yi, Zeng Xi-Xi, Xiang Xi, Liu Dun, Zheng Jin-Peng, Hu Bing
Department of Orthopaedics, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430000, Hubei, China;
Zhongguo Gu Shang. 2019 Oct 25;32(10):965-970. doi: 10.3969/j.issn.1003-0034.2019.10.019.
To compare the clinical results between the Wiltse approach and traditional approach in lumbar fusion.
The clinical data of 70 patients with lumbar disc herniation or lumbar spondylolisthesis within Meyerding II degree who underwent lumbar fusion surgery from May 2016 to May 2017 were retrospectively analyzed. According to the surgical approach, the patients were divided into Wiltse approach group and traditional approach group. A total of 35 patients in Wiltse approach group, included 18 males and 17 females, with an average age of (52±11) years old;other 35 patients in traditional approach group, included 19 males and 16 females, with an average age of (51±14) years old. Included 38 patients with lumbar disc herniation and 32 patients with spondylolisthesis of Meyerding II degree. The operation time, intraoperative blood loss and postoperative drainage, the VAS score of low back pain and leg pain, the level of creatine phosphokinase (CK) and the cross-sectional area of multifidus muscl on MRI were recorded.
The operation time, intraoperative blood loss and postoperative drainage in Wiltse approach group were less than in traditional approach group(<0.05). There were significant differences in VAS score of low back pain at 7 days and 3 months after operation between two groups(<0.05). VAS of back pain at both 7 days and 3 months showed better results (<0.05); VAS of leg pain showed better results in 3 months but had no significant difference in 7 days. There was no significant difference in VAS score of leg pain at 7 days after operation between two groups(>0.05), but at 3 months had significant difference(<0.05). The peripheral blood CK levels at 1 day and 3 days after operation respectively were(400±103)U/L and (176±58)U/L in Wiltse approach group, while in traditional approach group were (598±57) U/L and (222±50) U/L, with statistical significance between the two groups(<0.05). Preoperative cross-sectional area of multifidus muscl on MRI was (424±66) mm² in Wiltse approach group and (428±82) mm² in traditional approach group, there was no significant difference between two groups(0.8); at 3 months after operation, in Wiltse approach group was (347±73) mm² and in traditional approach group was(239±78)mm², there was significant difference between two groups(<0.05).
For lumbar spinal fusion surgery, compared with the traditional approach, Wiltse approach has advantages of shorter operation time, smaller paravertebral muscles injury, and obviously releasing postoperative low back and leg pain. However, in determining the surgery program, the surgical operater also should fully recognize that the anatomical differences of Wiltse approach may influence on operation.
比较腰椎融合术中Wiltse入路与传统入路的临床效果。
回顾性分析2016年5月至2017年5月行腰椎融合手术的70例腰椎间盘突出症或Meyerding II度以内腰椎滑脱患者的临床资料。根据手术入路，将患者分为Wiltse入路组和传统入路组。Wiltse入路组共35例患者，其中男性18例，女性17例，平均年龄（52±11）岁；传统入路组35例患者，其中男性19例，女性16例，平均年龄（51±14）岁。包括38例腰椎间盘突出症患者和32例Meyerding II度腰椎滑脱患者。记录手术时间、术中出血量、术后引流量、腰背痛和腿痛的视觉模拟评分（VAS）、肌酸磷酸激酶（CK）水平以及MRI上多裂肌的横截面积。
Wiltse入路组的手术时间、术中出血量和术后引流量均少于传统入路组（<0.05）。两组术后7天和3个月时腰背痛的VAS评分存在显著差异（<0.05）。术后7天和3个月时背痛的VAS评分均显示出更好的结果（<0.05）；术后3个月时腿痛的VAS评分显示出更好的结果，但术后7天时无显著差异。两组术后7天时腿痛的VAS评分无显著差异（>0.05），但术后3个月时有显著差异（<0.05）。Wiltse入路组术后1天和3天外周血CK水平分别为（400±103）U/L和（176±58）U/L，而传统入路组分别为（598±57）U/L和（222±50）U/L，两组间有统计学意义（<0.05）。术前MRI上Wiltse入路组多裂肌的横截面积为（424±66）mm²，传统入路组为（428±82）mm²，两组间无显著差异（0.8）；术后3个月时，Wiltse入路组为（347±73）mm²，传统入路组为（239±78）mm²，两组间有显著差异（<0.05）。
对于腰椎融合手术，与传统入路相比，Wiltse入路具有手术时间短、椎旁肌肉损伤小、术后腰腿痛明显缓解等优点。然而，在确定手术方案时，手术操作者也应充分认识到Wiltse入路的解剖差异可能会对手术产生影响。
