肌间隙入路和传统入路在腰椎融合术中的对比研究 |
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投稿时间:2018-11-19 修订日期:2019-09-27
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期刊信息:《中国骨伤》年,第卷,第期,第-页 |
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中文摘要:目的:比较经肌间隙入路和传统入路对腰椎融合手术患者的影响。方法:回顾性分析2016年5月至2017年5月收入院的因腰椎间盘突出或II度以内腰椎滑脱行两个节段以内腰椎融合手术的患者共70例。患者分为两组:肌间隙入路组35例,男18例,女17例,平均年龄52岁;传统入路组35例,男19例,女16例,平均年龄51岁。两组中包括腰椎间盘突出症38例,腰椎滑脱32例。记录两组患者的手术时间、术中出血量,术后引流量、腰腿痛VAS评分、外周血CK浓度以及MRI上多裂肌横截面积。结果:与传统入路组相比较,肌间隙入路组手术时间、术中出血量以及术后引流量少(p<0.05);比较两组患者的VAS腰痛评分,术后7天和3个月有显著差异(p<0.05);比较两组患者VAS腿痛评分,术后7天无明显差异(p>0.05),3个月有显著差异(p<0.05);术后1天和3天外周血CK浓度平均值(U/L):肌间隙入路组分别为(400±103)和(176±58),传统入路组分别为(598±57)和(222±50),两组间差异具统计学意义(p<0.05)。比较两组患者间MRI上多裂肌横截面积平均数(mm2):肌间隙入路组术前为(424±66),传统入路组术前为(428±82),两组间术前面积差异无统计学意义(p=0.8);肌间隙入路组术后3个月为(347±73),传统入路组术后3个月为(239±78),两组间术后3个月面积差异有统计学意义(p<0.05)。结论:行腰椎融合手术,肌间隙入路与传统后正中入路相比,确实拥有手术时间短、对椎旁肌损伤小、术后腰腿痛缓解明显等优势,但在确定手术方案时,术者也应充分认识到Wiltse间隙在不同层面的解剖学差异可能对手术操作产生的影响。 |
【关键词】腰椎融合术,肌间隙入路,传统入路 |
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A comparative study of lumbar fusion surgery with the Wiltse approach and the traditional approach |
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ABSTRACT Objective:To compare the clinical results between the Wiltse approach and traditional approach in lumbar fusion. Methods: In this retrospective controlled study, from May 2016 to May 2017, 70 cases with lumbar fusion surgery under the microscope for lumbar disc herniation or lumbar spondylolisthesis within Ⅱdegree were assigned to Wiltse approach (35 cases,18 males and 17 females; mean age 52 years) and traditional approach groups (35cases, 19 males, 16 females; 51 years). There were 38 cases of lumbar disc herniation and 32 cases of II degree spondylolisthesis in two groups. The operation time, the amount of blood loss and post-operation drainage, the VAS score of low back and leg pain, the level of creatine phosphokinase (CK) and the reduction of CSA in magnetic resonance imaging (MRI) were recorded. Results: After the operation for the Wiltse approach group, there was less operation time, blood loss and post-operative drainage ,VAS of back pain at both 7days and 3 months showed better results (p<0.05) ; VAS of leg pain showed better results in 3 months but had no significant difference in 7 days. The peripheral blood CK levels was changed in 1 day and 3 days (U/L) : the Wiltse approach group, respectively (400±103) and (176±58), the traditional approach group, respectively (598±57) and (222±50),statistical significance difference between the two groups (p < 0.05);On the comparison of average multifidus muscle cross-sectional area (mm2)on MRI between the two groups patients : the average area of the Wiltse approach group patients before the operation is 424±66, the traditional approach group is 428±82, which tells the difference of preoperative area between the two groups had no statistical significance (p = 0.8); the average area of the Wiltse approach group patients 3 months after the operation is 347±73, the traditional approach group is 239±78, which tells the difference of the area of 3 months after the operation between the two groups has statistically significant (p < 0.05). Conclusion: lumbar fusion surgery, muscular clearance approach compared with the traditional after the middle of the road, do have shorter operation time, small to vertebral side muscle injury, postoperative lumbocrural pain relief obvious advantages, but in determining the operation program, the performer also should fully recognize the Wiltse clearance at different level of anatomical differences may influence on the operation. Conclusion: For lumbar spinal fusion surgery, compared with the traditional approach, the Wiltse approach do the advantages of full visual space, intuitive and clear field, and exact effect of the fusion, the Wiltse approach do have such advantages as shorter operation time, smaller vertebral side muscle injury, and less postoperative lumbocrural pain. However, in determining the operation program, the performer should fully also recognize that the Wiltse clearance at different level of anatomical differences may influence on the operation. |
KEY WORDS Lumbar fusion surgery The Wiltse approach The traditional approach |
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