Wiltse入路椎弓根螺钉固定治疗腰椎间盘突出症的疗效观察  

The Curative Effect of Pedicle Screw Fixation by Wiltse Approach on Lumbar Disc Herniation

作　　者：杨剑[1] 康建平[1] 王松[1] 雷飞[1] 

机构地区：[1]泸州医学院附属医院脊柱外科,四川泸州646000

出　　处：《西南军医》2014年第3期257-260,共4页Journal of Military Surgeon in Southwest China

摘　　要：目的比较Wiltse入路(肌间隙入路)椎弓根螺钉固定融合术(A组)与传统腰椎后正中入路椎间融合术(B组)治疗腰椎间盘突出症(Lumbar disc herniation,LDH)的临床疗效。方法 285例腰椎间盘突出症接受手术治疗的患者分为两组,A组120例,B组165例。比较两种手术入路术中出血量、手术时间、术后并发症,术后卧床时间、融合率,术前、术后随访均应用腰痛和腿痛视觉模拟(Visual analogue pain score,VAS)评分、Oswestry功能障碍指数(oswestry disability index,ODI)评分、下腰痛(Japanese Orthopaedic Association,JOA)评分估计患者的恢复情况,并进行统计分析。结果 A组在术中出血量、手术时间、术后并发症、术后卧床时间、末次随访腰痛VAS评分及JOA评分方面明显优于B组(P<0.05),但A组末次随访腿痛VAS评分、ODI评分、融合率与B组相比无显著性差异(P>0.05)。两组末次随访腰腿痛VAS评分、ODI评分及JOA评分与术前比较有显著性改善(P<0.05)。结论 Wiltse入路椎弓根螺钉固定减压融合术与传统腰椎后正中入路固定减压融合术治疗腰椎间盘突出症均能取得满意的临床疗效,但前者具有出血少、创伤小、手术时间短、术后并发症发生率及腰痛残留率低,并能早期起床减少卧床并发症的发生等优点。Objective To compare the clinical curative effect of pedicle screw fixation by Wiltse approach with that of traditional lumbar interbody fusion by posterior median approachon lumbar disc herniation（LDH）. Methods 285 cases with lumbar disc herniation received surgical treatment and were randomly divided into 2 groups： group A（Wiltse approach）（n=120）and group B（posterior median approach）（n=165）; a comparative study was made between the 2 groups in bleeding in operation, time length of operation, postoperative complications, postoperative time in bed,the fusion rate; Visual Analogue Pain Score（VAS）, Oswestry Disability Index（ODI）and Japanese OrthopaedicAssociation（JOA）were applied in the follow-up before and after operation and the results were statistically analyzed. Results Group A was superior to group B in bleeding in operation, time length of operation, postoperative complications, postoperative time in bed,the scores of VAS and ODI in the last follow-up（P0.05）while there existed no obvious difference in VAS scores, ODI scores and fusion rate between the 2 groups（P0.05）; the VAS scores, ODI scores and JOA scores of both group in the last follow-up were more improved than those before operation. Conclusions Pedicle screw fixation by Wiltse approach and traditional lumbar interbody fusion by posterior median approach both are effective on LDH while the former is of such advantages as less bleeding, small wound, shorter operation time, lower occurrence of complications and lower residual rate of low back pain.

关 键 词：Wiltse入路 腰椎间盘突出症 内固定 减压 

分 类 号：R681.53[医药卫生—骨科学]