关键词: 腰椎手术 入路, 肌间隙, 损伤

Abstract:

Objective  To compare the influence of Wiltse approach and conventional approach on short-term postoperational recovery and muscle injury for patients received lumbar instrumentation and fusion.　Method　This is a Random Control Trial. Patients were randomized into bilateral Wiltse approach group (Group A) or bilateral conventional approach group (Group B). Decompression and fusion was performed unilaterally. Baseline Creatine kinase (CK), Aspartate aminotransferase (AST), Visual Analog Scale (VAS), Oswetry Disability Index (ODI) were measured. Drainage was placed on both side, and removed 48 hours after surgery. Operation duration and blood loss were recorded. CK and AST on postoperational Day 1 and Day 3, bilateral drainage volume within 48 hours after surgery, wound fluid volume measured by Ultrasonogram on postoperational Day 3, VAS and ODI on postoperational Day 5 and 3-month were recorded. Result　There were 57 patients in total, with 27 patients in Group A and 30 patients in Group B. There were no significant difference between the two groups in age, baseline CK, AST, VAS and ODI (P>0.05). Operation duration and blood loss were similar. There was no significant difference in drainage volume on fusion side within 48 hours after operation, but significant difference in contralateral drainage volume (P<0.05). There was significant difference in CK and AST on postoperational Day 1 but not on Day 3. There were significant differences in VAS and ODI between two groups on postoperational Day 5 and 3-month.　Conclusion　It is plausible to complete lumbar instrumentation and intervertebral fusion through Wiltse approach. Wiltse approach could reduce muscle injury during operation, which is favorable for short-term recovery of patients. 

Key words:  Lumbar surgery, Approach, Intermuscular, Injury